This legislation has the potential to drastically reshape the economics of healthcare in America, but it remains unfamiliar to those it affects most—namely, patients, doctors and outpatient surgery centers.
While the $900 billion that lawmakers included for urgent pandemic relief got most of the attention, some even bigger changes for health care were buried in the other parts of that huge legislative package.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
While the law is protecting patients, doctors say the limits on what insurers now pay has given the companies an unfair advantage in negotiations with doctors, which is leading to major changes in the industry that may affect patients.
A proposed rule takes a narrow exemption to the law ? intended to be used only when patients want a particular out-of-network doctor and agree to financial ramifications ? and instead would require all out-of-network providers in nonemergency situations to give patients that waiver, thereby creating confusion.
As Congress considers various plans and negotiates behind the scenes, data is trickling in from states that have been test-driving proposed solutions.
Physician-staffing companies — the two largest of which are owned by private equity firms — are benefiting greatly from the ability to bill out-of-network at a time when there is a bipartisan effort to end medical billing.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
The surprise medical bill legislation is an effort to help consumers who generally mistakenly thought they were getting health services covered by their insurers but instead find themselves dealing with an out-of-network provider.