CMS Issues Rule to Protect Consumers from Surprise Billing & New Report on Surprise Bills for Maternal & Newborn Care

Last Thursday, the U.S. Department of Health and Human Services (HHS) issued an interim final rule that aims to protect consumers from surprise and balance billing practices and restricting out-of-pocket costs. Surprise billing was a major campaign concern for both presidential candidates and the Biden Administration is acting on consumer protections initiatives that began under Trump.

The proposed protections aim to clearly outline charges that might be expected during medical emergencies, and will protect consumers from charges from out-of-network providers working at in-network facilities, Physician’s Weekly reports.

The new rule revolves around four core provisions, outlined by BenefitsPRO:

• Bans surprise billing for emergency services.
• Bans high out-of-network cost-sharing for both emergency and non-emergency services.
• Bans out-of-network charges for ancillary care at in-network facilities in all circumstances.
• Bans other out-of-network charges without notice.

From HHS Secretary Xavier Becerra in the Centers for Medicare & Medicaid press release on the new rule:

No patient should forgo care for fear of surprise billing. Health insurance should offer patients peace of mind that they wont be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises.

The largest source of unexpected costs to patients is maternal or newborn care, according to a JAMA Health Forum study. Modern Healthcare reports that one in five privately insured families with in-network child deliveries received surprise bills in 2019. The information for the study came from Optum’s Clinformatics Data Mart, a databased with information on more than 12 million privately insured enrollees nationwide.