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

When a person with health insurance receives services from an out-of-network provider unknowingly, rather than from an in-network provider, it can result in what is called “surprise billing.” Most commonly, this happens during a medical emergency or when a patient inadvertently receives nonemergency services at an in-network facility from an out-of-network provider. When this happens, the insurer may not pay the bill or may pay only a portion of the bill and the out-of-network provider may bill the enrollee for the balance.

Read the op-ed here.