Patients are still receiving surprise medical bills, including for medical lab tests, despite the enactment of the no-surprise federal law that became law on January 1, 2022

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Survey respondents specifically mentioned clinical laboratory fees as part of the balance billing they received

Unexpected medical bills, which often include fees for clinical laboratory and pathology tests, still arrive in patient mailboxes, even though the federal government law without surprise (HR3630) was adopted as part of the Consolidated Appropriations Act, 2021 specifically to prevent this from happening.

According to a survey conducted by Morning consultationa global research company with offices in New York, Washington, DC and San Francisco, 20% of patients said they or a family member received an unexpected medical bill in 2022.

Notably, survey respondents specifically mentioned fees for clinical laboratory tests as part of the contingency billing they received.

“Adults who received unexpected bills this year were more likely to receive them for in-network lab work that was sent to an out-of-network lab for evaluation, which is covered by law, or for tests or procedures not covered by insurance, which it is not,” a Morning Consult Press release Noted.

Morning Consult surveyed more than 2,000 adults between June 22-24, 2022, according to the published results.

“The No Surprise Act has ended the practice of surprise medical billing in most cases, providing relief to millions of patients who have faced surprise medical bills they never expected,” said Mast Eyles (above), President and CEO, America’s Health Insurance Plans, in a AHIP press release. “But there is still work to be done,” he added. Clinical laboratory managers should be aware of federal law before billing their patients. (Photo copyright: business thread.)

When the law works and when it doesn’t

In “Judge strikes down law provision with no surprises“, Daily Dark sister edition, The dark reportexplained that the No Surprises Act is intended to protect policyholders from receiving unexpected medical bills for unscheduled emergency care or services, including clinical laboratory tests, that they unknowingly received from outside providers. network.

However, certain provisions of the law may thwart its intention.

“[The No Surprises Act] does not apply if a patient sees their own primary care physician or another physician in the community and that physician refers that patient to an out-of-network lab,” a health care attorney said. Charles Dunham IVshareholder of a law firm Greenberg Traurig LLP in Houston, says The dark report. “Generally, this applies to emergency departments or a non-emergency department where the patient is inpatient or outpatient in an in-network hospital and uses an out-of-network lab.”

Bills for lab tests and other services surprise patients

Healthcare services cited by most Morning Consult survey respondents as resulting in unexpected medical bills include:

  • Examinations or procedures not covered by insurance, 34%.
  • Laboratory work in a hospital or in-network healthcare facility that was sent to an out-of-network lab for evaluation, 32%.
  • Treatment by an out-of-network physician or specialist at an in-network hospital or health facility, 21%.
  • Treatment in an out-of-network hospital or health facility, 19%.
  • Transport to an emergency department by an out-of-network ambulance, 18%.

Clinical lab tests were the top unanticipated charge, which typically amounted to more than $1,000, according to 22% of those who received a balance billing.

Could billing disputes get worse?

Pathologists’ offices, medical laboratories and other providers who do not comply with the law without surprise can be at risk. And, unfortunately, a Health Care Cost Institute study according to a Daily Dark electronic briefing.

“It is possible that providers who continue to bill patients who break the law unsurprisingly will be targeted by the US Department of Justice some time in the future, possibly years from now. So there is a risk,” said Michael RobertChief Editor of Daily Dark and The dark report.

“Additionally, patients who realize that the bills they received from healthcare providers were in violation of the law without surprises could potentially bring class action lawsuits against those providers,” Michel added.

In fact, 63% of people surveyed by Morning Consult expressed confidence in their ability to handle a surprise bill that they deemed illegal. Thus, health care providers, clinical laboratory managers, and pathology group managers are encouraged to deepen their understanding of the federal prohibition on certain types of balance billing.

“As the administration continues to work to implement the law, it must continue to keep patients out of billing disputes and educate patients and providers about the law,” a doorman said. -word of Senator Maggie Hassan (DN.H), a co-sponsor of the No Surprises Act (NSA), in the Morning Consult press release.

Only 16% of adults surveyed said they were aware of the law without surprise, compared to 19% when the law was launched in January, according to the study.

Another study finds the NSA is making progress

US health insurance plans (AHIP) and the Blue Cross and Blue Shield Association (BCBS) conducted a survey commercial health plans. According to their findings, in its first two months, the no-surprise law may have prevented two million surprise bills from reaching commercially insured patients, and it is possible that 12 million surprise bills will be avoided in 2022.

Although a much smaller survey, the 31 respondents to the AHIP-BCBS study represented 115 million commercial enrollees or 54% of the total commercial insurance market. The data they shared included:

  • Number of commercial claims incurred and paid in January and February.
  • Many of these claims that were eligible for the law without surprises.

From that data, the study found 600,000 law-eligible claims with no surprises in the marketplace in January and February. Following calculations using 2020 census data on commercial registrants (213 million), the study’s authors estimated that the unsurprising law could stop 12 million unplanned health care bills in 2022.

Surprise medical bills can also be avoided with new hospital price transparency laws and state-led affordable drug initiatives, according to Insider information.

Tracking Ideas for Clinical Labs

Clinical laboratory tests will likely be the focus of further studies on the law’s effectiveness, unsurprisingly. Managers of medical laboratories and pathology groups may wish to check with reference laboratories and partner billing companies to ensure compliance with the latest federal laws regarding balance billing.

Donna Marie Pocius

Related information:

Morning Consult National Tracking Survey

Surprise medical bills have been banned since January. One in five Americans say they or their family received an unexpected charge anyway

Over two million surprise bills avoided from January to February 2022

No Surprise Law Has Prevented More Than Two Million Potential Surprise Bills For Insured Consumers, New Study Shows

Unexpected medical bills are plaguing US consumers – Here are two main reasons why it could get better soon

Judge strikes down law provision with no surprises

Health Care Cost Containment Study Finds Pathologists Bill Out-of-Network More Frequently Than Other Specialties

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