Understanding How Surprise Medical Bills Are Changing

In its most recent package of bills aimed at helping Americans during the coronavirus pandemic, Congress included a measure that will impact how medical debts are collected nationwide as it attempts to grapple with a problem that has plagued the healthcare industry for a number of years: surprise medical bills.

A patient generally receives a surprise medical bill when he or she has a medical emergency. The patient may visit an emergency room that is not part of his or her healthcare network, and may be treated by a physician who is not covered by the patient’s health insurance. In some cases, patients have received surprise medical bills totaling tens or hundreds of thousands of dollars and are on the hook for all of that by themselves.

In many, if not all of these cases, the patient is not in a position to shop around for the best price or inquire about whether a doctor is part of his or her insurance policy. And that is why the bills often come as a surprise. Some studies have indicated that as many as 20% of all visits to an emergency room end up with a surprise medical bill, with the average size of a surprise medical bill reaching more than $600. Not surprisingly, the majority of consumers are in favor of having surprise medical bills banned outright.

Under the terms of the bill, physicians would be prohibited from billing a patient for a healthcare visit or procedure unless an estimate was provided 72 hours in advance or the patient provided his or her consent to the procedure.

For healthcare providers and the companies that specialize in collecting on healthcare debt, this could mean major changes to billing practices and collection procedures. Documenting the process of obtaining consent from a patient is going to be essential if the provider wishes to try and collect on a bill. If the providers does not have the proper consent to do so, it must work with the patient’s health insurance company to negotiate a price, or leave it to an arbitrator to make a decision. Healthcare providers are afraid that the law will result in them being forced to charge less for their services, which means making less money, especially as they grapple with the challenges of the coronavirus pandemic.

Companies that collect on healthcare debts will need to make sure that the debts that are placed with them are not subject to the new law.