What Keeps One Advocate up at Night About the No Surprises Act

What Keeps One Advocate up at Night About the No Surprises Act
What Keeps One Advocate up at Night About the No Surprises Act

The No Surprises Act, which took effect January 1, 2022, brought with it several protections for Americans against surprise medical bills. Patricia Kelmar, healthcare campaigns director at the Public Interest Research Group, advocated for this law, which helps prevent patients from receiving surprise bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities and services from out-of-network air ambulance providers.

But there’s one thing that keeps Kelmar up at night — that providers can ask patients to waive their surprise billing protections, she said Tuesday when speaking at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum in Washington, D.C.

“There are other providers who are allowed to step in front of you, either before as you’re scheduling care, or when you’re already in the hospital and say, ‘Hey, I’m out-of-network but I’m here now. I could provide you care, just sign this form and I’ll give you an estimate of my charges and I could do it for you right now. You don’t have to reschedule or anything.’”

This form is called the Surprise Billing Protection Forman ironic name, Kelmar declared.

“It is literally not the ‘Surprise Billing Protection Form.’ It is the ‘I’m giving up everything Patricia Kelmar and her colleagues fought very hard for.’ This waiver form literally takes all those protections away and sets you up to pay those out-of-network charges,” she said.

She emphasized that the estimated price is in fact just an approximated amount and is not final.

“It clearly says on that form that this is not a contract, so ultimately the patient will have to pay,” Kelmar said. “There’s nothing in the law that gives them an ability to challenge that price or to fight back in any shape or form.”

Kelmar called on the health plans at the conference to help track patients who are signing the Surprise Billing Protection Form.

“No one’s keeping track of it,” she said. “It worries me that certain providers will be very effective … in getting patients to sign these forms and setting people up for surprise billing.”

Another area of concern for Kelmar is that the No Surprises Act applies to specific locations, such as hospitals and urgent care centers licensed to provide emergency care, she said.

“As if any of us know which urgent care center around the corner is licensed to give emergency care. … I think we can expand the protections, assuming we can get all the problems worked out in the No Surprises Act. There’s more to be done on that,” Kelmar stated.

Photo: KLH49, Getty Images

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