New Surprise Billing Regulation Could Favor Providers

  • Aug 26, 2022

    In the latest round of rulemaking on the No Surprises Act (NSA), the 2020 law that bans most balance medical billing, providers won concessions from the Biden administration regarding the calculus arbitrators must use to decide billing disputes. One expert tells AIS Health, a division of MMIT, that the new regulation, which takes recent pro-provider court decisions into account, is likely to reduce the amount of cost savings the NSA generates for payers.

    The NSA bans the practice of balance, or “surprise” billing. Surprise bills typically involved pricey emergency care, and frequently saddled patients with crippling amounts of medical debt — often tens of thousands of dollars. Patients were charged the cost of care delivered by providers outside their insurance network when the plan and provider couldn’t agree on a fair price for treatment. The law compels health plans and providers to attempt to work out the balance billing disputes between themselves. Read more
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  • Peter Johnson

    Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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