The Provider Relief Fund: How Well Does it Protect Patients from Surprise Medical Bills for COVID-19 Related Services?

The $175 billion Provider Relief Fund prohibits participating providers from balance billing COVID-19 patients, regardless of their source of coverage. While this could help many patients avoid surprise medical bills, there remain several questions about the scope of protection this will provide. In an update to his April 30, 2020 post, Georgetown expert Jack Hoadley takes a look at the fine print of the program as well as new guidance from HHS. Continue reading

In the Age of COVID-19, Short-Term Plans Fall Short for Consumers

During February’s State of the Union address, President Trump touted his administration’s efforts to expand access to short-term health plans that do not comply with any of the ACA’s consumer protections. Short-term plans are often cheaper than ACA-compliant plans because they can deny coverage to people and exclude entire categories of services. In a recent post supported by The Commonwealth Fund, we reviewed 12 short-term plans to determine what coverage consumers would have if they needed treatment for COVID-19. We found that consumers in short-term plans are likely to have less financial protections than those enrolled in ACA plans. Continue reading

How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing

As Congress and a number of states craft legislation to protect consumers from surprise out-of-network billing, a critical issue is resolving how insurers will pay out-of-network providers for their services. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR’s Jack Hoadley and Maanasa Kona assess the experience of states that use an independent dispute resolution process to determine these payments. Continue reading

Addressing Surprise Billing by Setting Payment Standards for Out-of-Network Providers

The thorniest issue in pending legislation to protect consumers from surprise medical billing is how to resolve disputes between payers and providers over appropriate payment. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR experts Maanasa Kona, Jack Hoadley, and Katie Keith examine the seven states that have adopted a payment standard for out-of-network bills. Continue reading

Update on Federal Surprise Billing Legislation: New Bills Contain Key Differences

Congressional leaders are racing to meet a self-imposed May deadline for passing legislation to protect consumers from surprise medical billing. In their latest post for the Commonwealth Fund’s To the Point blog, Jack Hoadley, Beth Fuchs, and Kevin Lucia identify key similarities and differences among competing proposals, and provide a comprehensive side-by-side guide to the key committee bills. Continue reading

The Texas Two-Step: Implementation of State Balance Billing Law Reveals Gaps in Consumer Protections

In Congress and state legislatures across the country, policymakers are debating fixes to surprise medical bills. The federal government has yet to enact comprehensive reforms, but a number of states have taken steps to protect consumers. One such state is Texas, which last year enacted a new law holding consumers harmless in situations that commonly lead to surprise medical bills. However, the state’s new protections were almost gutted due to an implementation loophole, a cautionary tale for federal and state policymakers. CHIR’s Rachel Schwab takes a look at what happened in Texas. Continue reading

New Resource for Consumer Advocates on Out-of-Network Payment Disputes in Balance Billing Legislation

State lawmakers across the country are are gearing up for a new legislative session. Many will be considering state-level protections for consumers to prevent surprise out-of-network medical bills. Just as with the federal legislation, however, one of the key sticking points for state policymakers will be how to approach out-of-network provider reimbursement. To aid stakeholders in these efforts, Community Catalyst teamed up with CHIR experts to create a guide for its health insurance reform toolkit: The Advocate’s Guide to Addressing Out-Of-Network Payment in Surprise Balance Billing Legislation. Continue reading