Tag: balance billing

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

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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.

States Can Prevent Surprise Bills for Patients Seeking Coronavirus Care

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In their latest post for the Commonwealth Fund’s To the Point blog, Jack Hoadley, Maanasa Kona, and Kevin Lucia explore recent state activity to enact balance billing legislation, as well as ways in which some states have used emergency powers to protect people from surprise medical bills for COVID-19-related services.

February Research Round Up: What We’re Reading

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This February, CHIR’s Olivia Hoppe reviewed new research on health care costs and utilization, surprise bills after in-network elective surgery, acquisition of physicians by private equity firms, and rates of charity care by nonprofit hospitals.

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

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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.

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

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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.

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

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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.

January Research Round Up: What We’re Reading

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To kick off 2020, CHIR’s Olivia Hoppe reviews studies on out-of-network billing from hospital-based physicians, the Affordable Care Act’s effect on racial and ethnic access disparities, health care market consolidation, and 2020 marketplace premiums and insurer participation.

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

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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.

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

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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.

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.