It is rare to have good news in the healthcare world, as the past 20 months have underscored for all of us.

But on January 1, health care consumers, including federal employees and retirees, will see the end of a problem that isn’t necessarily a daily aggravation, but is really silly when it appears.

In this case, the problem often occurs when a patient goes to a network hospital but receives treatment from an off-network provider – and receives a high bill after they were not expecting it. Surprise bills may be more common after emergencies, perhaps when anesthesia is involved, said Walt Francis, health policy analyst and author of the annual Consumer’s Checkbook to Health Plans for Federal Employees.

“Of course you want your life saved; you’re not going to start asking doctors about their fees, ”he said.

Last year, Congress found a way to protect Americans from surprise bills. Yes, in the midst of political wrangling, Congress is always able to identify a problem, do its homework, and pass legislation designed to resolve or at least alleviate that problem.

In this case, the legislation was the No Surprise Act, which Congress included in the 2021 omnibus spending program and which former President Donald Trump enacted the law at the end of last December.

The Bureau of Personnel Management, along with the Ministries of Labor, Treasury, and Health and Human Services, have issued a series of new regulations implementing the No Surprises Law in recent months.

The new rules come into effect Jan. 1 and apply to nearly all public and private health insurance plans across the country, including the Federal Employee Health Benefits program. Medicare and Medicaid already have similar rules, which are quite complicated and lengthy.

But in the future, emergency services, regardless of where you receive them and who performs them, should be treated as if they were on a network.

Insurance companies can no longer charge off-grid prices for ancillary care (such as an anesthesiologist) at a network hospital.

Patient co-payments or deductibles for emergency and elective services should be treated as if they were networked. And patients must give their consent to receive off-grid care before a doctor can bill at that higher off-grid rate.

Francis said there were still a few minor loopholes, but overall it’s a big deal.

“It’s a big reform,” he said. “The anesthesiologist who is not part of any plan network can always charge more, but the plan itself becomes an intermediary and protects the patient from a surprise bill. “

“This is one of the aggravations of life that is about to go away,” Francis added.

Surprise billing doesn’t happen to everyone, but it is quite common. Announcing the regulatory changes earlier this year, the Biden administration estimated that one in six emergency room visits and hospital stays involved care from at least one off-grid provider, resulting in a surprise bill. .

Francis said that’s why health plans with larger networks, like Blue Cross and Blue Shield, are so popular. Feds like the peace of mind that if, for example, an emergency strikes, they can go to the hospital and feel reasonably confident that the majority of physicians are part of their network there.

Now, federal authorities should have more peace of mind, regardless of their health plan, the next time the unexpected happens. These plans are responsible for ensuring that their patients are not billed more than the normal rate.

Of course, these changes should not mean that federal employees ignore the basic rules of choosing an appropriate medicare plan.

Francis suggests that FEHB participants check with their doctor every year if they plan to stay in their preferred network, and then research the new benefits of your current regimen and others.

Plans change every year and almost all insurers add new perks or perks to compete with others and meet OPM priorities for FEHBP.

Of course, now is the time to check with your doctors and research these plans. The opening season is running now and ends on December 13th.

We always answer your questions about the open season and answer one or two each day on the Federal Drive with Tom Temin. We cannot choose your health plan for you, but we can call on our network of experts to answer all your general questions about the open season, FEHB, etc.

Please feel free to ask your questions here.

Almost useless factoid

By Amelia Brust

In the southwest of Australia, in the town of Wellington Mill, a humble roundabout houses thousands of statues of gnomes. Nicknamed “Gnomesville”, the roundabout was originally protested by neighbors and the first gnome appeared without explanation. After a few months there were about 20 of them, and over time the collection grew to create one of the most popular tourist attractions in the country.

Source: Atlas Obscura