Medical Cost Disputes to Be Settled by Arbitrator

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The Biden administration issued the second of two rules under the non-surprise act aimed at limiting out-of-pocket medical costs

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The new system stems from the No Surprise Act, a landmark law for patient advocates and lawmakers as it aims to limit out-of-pocket costs for unexpected medical bills. It applies to the more than 130 million people with employer-sponsored health plans covered by federal law and many who live in parts of the country without state-based legislation that bans surprise bills. The 2020 No Surprise Act will come into force from January 1.

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The law instructs insurers and providers who cannot agree on a reimbursement amount to submit to arbitration. It also tasked the administration with setting up an independent resolution process, with hospitals and insurers disputed over whether the system would financially favor the other, as third-party dispute resolution could affect their bottom lines.

“Have you ever experienced a surprise bill? Then you know why it’s so important,” Department of Health and Human Services Secretary Javier Becerra said in an interview. “If it’s a surprise bill, maybe it’s There was an emergency or some kind of out-of-network treatment that you needed… it’s really an issue of peace of mind.”

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(more to come)

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