Pictures of large medical bills are sometimes shared on social media to show how patients can be blindsided by unexpected costs for care, but as the new year begins, consumers will be offered federal protections to avoid health-care sticker shock.

On Saturday, the No Surprises Act takes effect. Supporters said it will block out-of-network providers from sending large bills to patients who did not choose who cared for them in an emergency situation.

Patricia Kelmar, health care campaigns director for the Public Interest Research Group (PIRG), said getting statements in the mail can be very hard for the many Americans who don't have much in the savings accounts to cover the expenses.

"And when you think about the average out-of-network bill for anesthesia is $1,200, these costs can create a real burden on consumers and can lead to medical debt," Kelmar explained.

She noted under the law, your bill cannot be sent to collections while you have a complaint under review. Groups such as the American Medical Association have sued the federal government, saying while they back the law, they oppose the arbitration process drawn by regulators. And the North Dakota Health Information Management Association worries it could force smaller providers out of business.

The statewide group said consumer protections are needed, but argued the process caters to larger providers who have more patient volume.

Kelmar contends the law is trying to establish reasonable fees based on average contracted rates in a community.

"We're seeing higher-than-average, higher-than-market prices from many specialties that use surprise billing as a way to increase their profits," Kelmar contended.

She added more emergency rooms are being staffed by private-equity firms using contracted specialists.

Groups such as PIRG pointed out while the law will make a difference, they have suggested changes of their own. Kelmar noted the measure addresses air-ambulance service from-out-of-pocket providers, but leaves out ground transport.

"Your ground transportation, the ambulance that we think of when we call 911, those bills from an out-of-network ambulance could still be your financial responsibility," Kelmar cautioned.

According to federal estimates, the law will impact roughly 10 million surprise medical bills each year. Nearly 30 states have similar protections in place, but policy experts say they're often limited in scope. North Dakota is among the states without these protections.

Air travelers could face fewer obstacles in securing a refund if their flight is canceled or changed under new federal rules announced Wednesday.

The moves are being praised by watchdog groups. The Department of Transportation said airlines are now required to promptly provide passengers with automatic cash refunds when they are owed one.

Teresa Murray, consumer watchdog director for the U.S. Public Interest Research Group, said some carriers have not adhered to standards, leaving passengers in a bind.

"They would drag their feet, and they would say, 'Well, you bought your ticket from a ticket agent, so we don't know where your money is. Or, here, have a voucher,'" Murray explained.

Amid higher complaint volumes, companies will be forced to act quickly. The new rules, which are being phased in, provide clearer definitions for travel disruptions, including delays of at least three hours on a domestic flight and six hours on international flights. A key industry group responded to the announcement by touting transparency efforts among carriers.

Murray acknowledged most people are not frequent flyers, and it is hard for them to keep up on all the least practices and policies among airlines.

"The average person only flies once every 18 months," Murray pointed out. "This will just bring transparency to that process and it kind of evens the playing field."

Murray added it could come in handy for Midwestern customers when a winter storm wreaks havoc on air travel. The new rules also require refunds for baggage fees when a piece of luggage is delayed by 12 hours or more for domestic flights. And there must be upfront disclosure on fees for first and second checked bags and carry-on bags.


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Wisconsin lawmakers recently debated reforms for payday loans. Efforts to protect consumers come amid new research about financial pain associated with cash advances offered through smartphone apps. The Center for Responsible Lending is out with findings that detail how "earned wage advances" from digital platforms come with extra costs disguised as things like tips. Traditional payday lenders are often criticized for charging excessive interest rates on loans that are usually around $500.

Lucia Constantine, a researcher with the Center for Responsible Lending, said customers are usually seeking smaller amounts from the apps, but she warns they can be just as costly.

"They are trapping consumers in a cycle of borrowing that is similar to that of a payday loan, " she said.

The report said after using these financial products, customers are seeing overdrafts on their checking accounts increase by 56% on average. Industry leaders deny they're barraging consumers with hidden fees, stressing that features such as suggested tips are optional. More broadly, a bipartisan payday loan reform bill in the Wisconsin Legislature failed to advance this month.

Constantine said like longstanding payday lenders, these cash advance apps can be hard to regulate. Meanwhile, she urged those in a bind to explore other options.

"[They should] try talking to their friends and family as a first source. The other option which I would recommend is reaching out to their credit union or banking institution to see if they can get some sort of small-dollar loan," she said.

She noted places such as credit unions typically provide more transparency on loan costs. According to the report, three-quarters of consumers took out at least one advance on the same day or day after a re-payment was posted.


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Food prices remain high, in Montana and across the country.

A new report by the Federal Trade Commission says the country's largest grocery companies are gouging consumers, by keeping prices artificially high.

Many grocers, retailers and wholesalers have consolidated to cut costs. Grocers continue to blame supply chain problems, even though regulators have said most of those issues have been resolved.

President of the advocacy group Farm Action, Angela Huffman, said retailers were doing more than making up for lost revenue during the pandemic-era supply chain disruptions - and the FTC report says they continue to do so.

"In 2021, the retailer revenues, they rose to more than 6% higher than their total costs, and that those profits are still going up," said Huffman. "So, in the first nine months of 2023, the profits increased to 7%."

At nearly 6.5%, Montana had the nation's ninth-highest grocery price increase in 2023.

The FTC data show Amazon, Kroger and WalMart each gained market share during and after the pandemic - while profits continued to rise.

Other large retailers and wholesalers have consolidated, which they say gives them more buying power and the ability to pass those savings on to customers.

Huffman said that isn't what's happening, and calls on regulators to fine the grocers, or more.

"This would be kind of the farthest extent of what they could do, but go so far as breaking them up," said Huffman. "In years past, they broke up the telephone companies and the railroads and, you know, that would be the ideal outcome for us, is to take away their excessive power."

Huffman also points to a 150% increase in egg prices in 2023, which producers blamed on the avian flu. The FTC says the disease did not justify the drastic price hike.