New HHS Rule May Spell Doom for Freestanding Emergency Room Operators

“Surprise bills” would be illegal under an interim final rule issued by the U.S. Department of Health and Human Services. For purposes of the proposed rule, surprise bills are viewed as those received from a healthcare facility or individual provider outside the patient’s insurance coverage after the patient has received services from that facility. While this could apply to any such situation (eg, a patient having an otherwise covered surgical procedure may receive a separate bill from a member of the surgical team who is not in-network), freestanding emergency rooms have become notorious for this practice. The rule may also affect UnitedHealthcare’s plan to bill patients for emergency room fees if review by UHC ultimately determines after the fact that the corresponding trip to the ED was for something nonemergent.