News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Survey respondents specifically mentioned clinical laboratory charges as part of the balance billing they were receiving

Unexpected medical bills—which often include clinical laboratory test and pathology charges—are still arriving in patients’ mailboxes, even though the federal No Surprises Act (H.R.3630) was passed as part of the Consolidated Appropriations Act, 2021 specifically to prevent that from happening.

According to a survey conducted by Morning Consult, a global research firm with offices in New York, Washington, D.C., and San Francisco, 20% of patients said they or a family member received an unexpected medical bill in 2022.

Notably, survey respondents specifically mentioned charges for clinical laboratory testing as part of the unanticipated balance billing they received.

“Adults who received unexpected bills this year were most likely to get them for in-network lab work that was sent to an out-of-network lab for assessment, which is covered under the law, or for testing or procedures not covered by insurance, which isn’t,” a Morning Consult news release noted.

Morning Consult polled more than 2,000 adults between June 22 and June 24, 2022, according to the published results.

Matt Eyles

“The No Surprises Act ended the practice of surprise medical billing in most circumstances, providing relief for millions of patients who faced surprise medical bills they did not expect,” said Matt Eyles (above), President/CEO, America’s Health Insurance Plans, in an AHIP news release. “But more work needs to be done,” he added. Clinical laboratory managers should be aware of the federal law before balance billing their patients. (Photo copyright: Business Wire.)

When the Law Works, and When It Does Not

In “Judge Vacates Provision in No Surprises Act,” Dark Daily’s sister publication, The Dark Report, explained that the No Surprises Act aims to protect insured individuals from receiving unexpected medical bills for unanticipated emergency care or services—including clinical lab tests—that they unknowingly received from out-of-network providers.

However, certain provisions of the law can counteract its intention.

“[The No Surprises Act] doesn’t apply if a patient goes to his or her own primary care physician, or another doctor in the community, and that doctor sends that patient to an out-of-network laboratory,” healthcare attorney Charles Dunham IV, a shareholder at law firm Greenberg Traurig LLP in Houston, told The Dark Report. “In general, it applies to emergency services or a non-emergency service where the patient is in an inpatient or outpatient setting in a hospital that’s in network, and they utilize a lab that’s out of network.”

Bills for Lab Tests, Other Services Surprise Patients

Healthcare services cited by the most respondents to the Morning Consult survey that resulted in unexpected medical bills include:

  • Testing or procedures not covered by insurance, 34%.
  • Lab work at an in-network hospital or healthcare facility that was sent to an out-of-network lab for assessment, 32%.
  • Treatment by an out-of-network physician or specialist at an in-network hospital or healthcare facility, 21%.
  • Treatment at an out-of-network hospital or healthcare facility, 19%.
  • Transportation to an emergency department by an out-of-network ambulance, 18%.

Clinical laboratory testing was at the top of the unexpected charges, which were typically more than $1,000, according to 22% of those who received balance billing.

Could Billing Disputes Escalate?

Anatomic pathology practices, medical laboratories, and other providers who fail to comply with the No Surprises Act may be at risk. And, unfortunately, a Health Care Cost Institute study in 2020 found pathologists second only to emergency medicine physicians as specialists who most often bill for out-of-network hospital charges, according to a Dark Daily e-briefing.

“It’s possible providers continuing to send patients bills that violate the No Surprises Act may be targeted by the U.S. Department of Justice at some future time, even several years from now. So, there is risk,” said Robert Michel, Editor-in-Chief of Dark Daily and The Dark Report.

“Also, patients who realize that bills they received from healthcare providers were in violation of the No Surprises Act could potentially file class action lawsuits against those providers,” Michel added.

In fact, 63% of those surveyed by Morning Consult expressed confidence in their ability to address a surprise bill they deemed illegal. Thus, healthcare providers, clinical laboratory leaders, and pathology group managers are advised to brush up their understanding of the federal ban on certain types of balance billing.

“As the administration continues to work on implementing the law, it must continue to keep patients out of the middle of billing disputes and raise awareness about the law among both patients and providers,” said a spokesperson for Sen. Maggie Hassan (D-N.H), a cosponsor of the No Surprises Act (NSA), in the Morning Consult news release.

Only 16% of adults surveyed said they were aware of the No Surprises Act, down from 19% at the law’s launch in January, the study found.

Another Study Finds NSA Making Progress

America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBS) conducted a survey of commercial health plans. According to their findings, in its first two months, the No Surprises Act may have prevented two million surprise bills from reaching commercially insured patients, and it is possible 12 million surprise bills may be averted in 2022.

Though a much smaller survey, the 31 respondents to the AHIP-BCBS study represented 115 million commercial enrollees or 54% of the total commercial insurance market. The data they shared included:

  • Number of commercial claims incurred and paid during January and February.
  • Number of those claims that were No Surprises Act-eligible.

From those data, the study found 600,000 No Surprises Act-eligible claims in the market in January and February. Following calculations using 2020 Census data of commercial enrollees (213 million), the study authors estimated the No Surprises Act may stop 12 million unexpected healthcare bills in 2022.

Surprise medical bills may also be prevented by new hospital price transparency laws and state-led affordable medication initiatives, according to Insider Intelligence.

Follow-up Ideas for Clinical Laboratories

Clinical laboratory tests will likely be a focal point in more studies about the No Surprises Act’s effectiveness. Medical lab and anatomic pathology group leaders may want to check-in with reference laboratory and billing company partners to ensure compliance with the most recent federal laws concerning balance billing.    

Donna Marie Pocius

Related Information:

Morning Consult National Tracking Poll

Surprise Medical Bills Have Been Banned Since January. One in Five Americans Say They or Their Family Have Gotten an Unexpected Charge Anyway

More than Two Million Surprise Bills Avoided During January-February 2022

New Study Shows No Surprises Act Prevented Over Two Million Potential Surprise Bills for Insured Consumers

Unexpected Medical Bills Plague US Consumers-Here are Two Key Reasons Why This Could Improve Soon

Judge Vacates Provision in No Surprises Act

Pathologists Bill Out-of-Network More Frequently than Other Specialties, According to Health Care Cost Containment Study