| | AUGUST 20238CIOReviewIN MY OPINIONBy Thomas LaGreca, Executive Director, Medical Revenue Recovery, Callagy Law, PCSeveral years ago, states began to enact "Surprise Medical Bill" Laws. The New Jersey Surprise Bill Law (SBL) took effect August 30, 2018 and the New York SBL had been enacted 3 years earlier. Today numerous states have SBL's, including California, Illinois, Texas, Florida, Ohio, Georgia, and many others. Approximately the same number of states do not have their own SBL. These state laws shield patients from large out-of-network (OON) balance bills, when the patient is treated by an OON medical provider through no choice of the patient. Accordingly, emergency and inadvertent OON treatment are the targets of the legislation. Fair enough. All applaud this purpose. The natural follow-up question, however, is how fair to the medical community is the reimbursement regime, and its concomitant arbitration process, since the OON provider is denied the ability to bill the patient for any balance beyond the allowed amount? To ensure fairness to the medical community the arbitration process should require the carrier to make the medical provider whole, filling in the gap created by protecting the patient from a balance bill.Though these state laws succeeded in protecting patients in these circumstances, each of these states, and the laws they passed, had jurisdiction only over medical claims involving THE FEDERAL NO SURPRISES ACT AND STATE "SURPRISE MEDICAL BILL" LAWS--WHAT ARE THEY AND WHY THE MEDICAL INDUSTRY NEEDS TO PAY ATTENTIONThomas LaGreca
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