Modern Healthcare Source Article | Highlights by Matt Zavadsky
Health insurer, employer groups call on Congress to end surprise billing
By Shelby Livingston
December 10, 2018
Nine groups representing health insurers, employers and consumers on Monday called for federal legislation to protect patients from surprise medical bills from out-of-network providers.
Surprise medical bills may arise when a patient unintentionally visits a doctor or healthcare facility that does not contract with the patient's health insurer. This sometimes occurs when patients are taken to an out-of-network emergency department during a crisis. Surprise billing is common, with 4 in 10 insured adults reporting they received a surprise medical bill in the last year, a Kaiser Family Foundation poll found in September.
The groups—which include powerful lobbyists like the Blue Cross and Blue Shield Association, America's Health Insurance Plans, the National Business Group on Health, and Consumers Union—called on Congress to prohibit providers from billing patients for costs not covered by the health plan when the out-of-network visit isn't the patient's fault. But they also said Congress should ensure any policy enacted doesn't increase premiums or discourage providers from joining a health plan's network.
The other organizations involved include the American Benefits Council, The ERISA Industry Committee, Families USA, the National Association of Health Underwriters and the National Retail Federation.
While the groups committed to keeping patients informed about which doctors and facilities are out of network, they ultimately pinned the blame for surprise billing on providers.
"When doctors, hospitals or care specialists choose not to participate in networks, or if they do not meet the standards for inclusion in a network, they charge whatever rates they like," the groups wrote. "The consequence is millions of consumers receiving surprise, unexpected medical bills that can often break the bank."
The CEOs of the American Hospital Association and the Federation of American Hospitals quickly hit back in a joint statement, saying health plans' inadequate provider networks for emergency care are one of the "root causes" of surprise medical bills.
While some states, including California, Connecticut, Florida, Illinois, Maryland and New York, have passed comprehensive consumer protection laws to protect patients from surprise out-of-network medical bills, the federal government has yet to tackle the issue. That may change soon. In August, a bipartisan group of senators introduced the Protecting Patients from Surprise Medical Bills Act, which would protect patients from large out-of-network charges if they were being treated at an in-network facility.