Understanding the new requirements of surprise billing

When an insured individual gets care from a provider who does not participate with his/her insurance plan, it is often the case  that the payer does not cover the full amount charged by the provider. In such cases, an out-of-network healthcare professional may bill such a patient for the remaining amount that has not been covered by an insurance plan. This is called “balance billing”. At the same time, patients may receive bills from their healthcare providers for specific services that are not covered by their benefit plan. Patients may not be aware of potential out-of-pocket responsibility for the care that they have received. Such patients receive “surprise bills” from their providers, i.e. bills that have not been expected. There are certain regulations aimed at preventing patients from getting unexpected bills. Namely, an Interim Final Rule called “Requirements Related to Surprise Billing; Part II.” was released by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury on September 30th, 2021. Read along to get the details of this legislation!