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NOTEBOOK – ONE GOOD READ: New parents’ $80K medical bill shows loopholes in No Surprises Act


I recently did a little digging on the new No Surprises Act that went into effect on Jan. 1 — a federal effort to reduce the number of cases of surprise billings by health care providers, often for out-of-network emergency care that puts patients in the middle of a hospital-insurer billing dispute. So this story by NPR caught my eye. (I saw it online, but didn’t hear it on yesterday’s “Morning Edition.”) The story details the ordeal a Utah family has gone through after the emergency delivery of their twins, who were being carried by a gestational surrogate. The insurer denied the charges, saying it lacked documentation that the neonatal intensive care for the twins qualified as an emergency. Though this happened in 2020, cases like this could still occur under the new law, NPR reported. And if you missed it, here’s an article I wrote in January about a legal challenge to the rules to implement the law, and what local medical groups have to say about it. Additionally, on Wednesday a federal judge ruled that the No Surprises Act arbitration process implemented by the U.S. Department of Health and Human Services violated the Administrative Procedure Act, Becker’s Hospital Review reported. The Texas Medical Association sued the Biden administration in October 2021 over the rules governing the arbitration process, which said arbitrators should assume the qualifying payment amount under the out-of-network rate should be assumed to be the median in-network rate set by health insurers. Presiding Judge Jeremy Kernodle agreed, saying the rule “places its thumb on the scale” for the qualifying payment amount, according to Law360.

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