Yeah, a Big F%$#ing Deal

Joe Biden has issued a rule banning surprise medical billing

I’m surprised, particularly its application to emergency services, where private equity has made surprise billing a central part of their profit generation strategies.  (Biden has a lot of PE types in the administration)

This is an very good, at least in the context of an executive order: (We really need a law to ban this)

The Biden administration on Thursday unveiled the first in a series of rules aimed at banning surprise billing.

The interim final rule bars surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services. It also prohibits out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons, as well as other out-of-network charges without advance notice.


While public health insurance programs like Medicare and Medicaid already prohibit balance billing, people with job-based coverage or individual health plans frequently and unknowingly accept care from an out-of-network provider before they are slapped with a surprise medical bill. The new rule aims to put a stop to that.


This first round of regulation applies to providers, air ambulance providers, group health plans, health insurance issuers and Federal Employees Health Benefits Program carriers. The rule takes effect in 60 days, but most provisions don’t apply until January 1. Providers and insurers have until September 1 to submit comments.

Air Ambulance providers have been charging insane rates over the past few years as PE has snapped up more services.

The private equity model of medicine is to drastically overcharge people in situations where they have no choice.

Under the new rule, health plans that cover emergency services cannot use prior authorization for those services and must pay for them regardless of whether the clinician is an in-network provider or emergency facility. Likewise, insurers can’t charge their enrollees higher out-of-pocket costs for emergency services delivered by an out-of-network provider. They also have to count beneficiaries’ cost-sharing for those emergency services toward their in-network deductible and out-of-pocket maximums.


The Biden administration is still working out the details about how the dispute resolution process will work. But Congress laid out the broad-brush strokes in December’s No Surprises Act, which passed as part of its end-of-year spending package. Providers and insurers will have 30 days to agree to a price for the medical services delivered. And if they don’t settle, they’re supposed to enter arbitration, during which each side will present a final offer and make their case for why their recommendation is best. The arbitrator must then pick one of the two offers. But they can’t split the difference.

MY guess is that the PE parasites will still find a way to rat-f%$# people, it’s king of their “thing”, but it looks to be significantly harder now.

Personally, I favor a government owned National Health Service as a solution, but this is a positive move.

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