No more surprise medical bills. What will that mean for insurance premiums?

Nancy Marshall-Genzer Dec 30, 2020
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Health workers in New York City carry a patient to an ambulance in April. Spencer Platt/Getty Images

No more surprise medical bills. What will that mean for insurance premiums?

Nancy Marshall-Genzer Dec 30, 2020
Heard on:
Health workers in New York City carry a patient to an ambulance in April. Spencer Platt/Getty Images
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Congress has finally done something about surprise medical bills — those unexpected charges from out-of-network health care providers that can add up to tens of thousands of dollars. Lawmakers tucked a provision banning the surprise bills into the $900 billion coronavirus relief package President Donald Trump signed earlier this week.  

One thing that’s not clear is how this might affect your insurance premiums.

It’s a nasty shock. Without realizing it, let’s say you were treated by a health care provider who was out of network. Surprise, you’re stuck with a huge bill.

Jen Taylor, with the consumer advocacy group Families USA, said some of the biggest unexpected medical bills come from air ambulances. “Where people were getting a $50,000 bill, and they were unconscious and put into an air ambulance and had no say in the matter,” she said.

Once this surprise medical bill legislation goes into effect in 2022, out-of-network providers like air ambulances won’t be able to send consumers unexpected bills. Instead, providers and insurers will have 30 days to negotiate how much the insurer will cover. If they can’t agree, an independent arbitrator would step in. 

“Each party submits their best offer and the arbitrator has to choose one or the other,” said Spencer Perlman, director of health care research at Veda Partners. He said using arbitration was a congressional compromise. Insurers had lobbied for benchmark rates, limiting charges. Some consumer advocates worry that insurers will raise premiums if they lose in arbitration. 

But Rice University health economist Vivian Ho thinks arbitration could actually save insurers money. And they could pass some of that savings along to consumers.

“This will slow the growth in premiums,” she said. “I’m not sure that we’ll actually see a reduction in premiums.”

The legislation also helps the uninsured, requiring the government to set up a process for resolving their billing disputes.

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