On July 1, the Biden Administration introduced an interim final rule instructing mediators to consider median in-network rates when determining how much an insurer will pay the provider. The rule also requires providers and hospitals to publicly post rules banning surprise bills on their websites, as well as requires the administration to have a process to review patient complaints of improper surprise bills.
The rule was put in place to protect participants, beneficiaries, and enrollees in group health plans and group and individual health insurance coverage from surprise medical bills when they receive emergency services, non-emergency services from nonparticipating providers at participating facilities, and air ambulance services from nonparticipating providers of air ambulance services, under certain circumstances.
The Biden Administration is expected to release additional rules in the fall and winter regarding resolving disputes between insurers and providers when a rate cannot be agreed upon.
To read the new rule, click here.
