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Analysis

Broad Coalition Unites Against Surprise Medical Bills

By John Commins  
   December 10, 2018

The nine-member group wants Congress to protect consumers from excessive out-of-network charges and require provider transparency on treatment options and costs.

Healthcare makes for strange bedfellows.

A motley group of health insurance, business, and consumer protection organizations have formed a broad coalition against surprise medical bills.

"Every American deserves affordable, high-quality coverage and care, as well as control over their own healthcare choices," the nine organizations, which include America's Health Insurance Plans, Families USA, and the National Retail Federation, said Monday in a joint media release.

The stakeholders each signed on to "guiding principles," agreeing that:

  • Federal laws are needed to protect patients from surprise medical bills.
     
  • Patients should be told when their services are out of network, and they have a right to know about the costs of their treatment and options.
     
  • Federal laws and policies designed to protect patients against surprise medical bills should not simultaneously raise premiums or care costs for consumers.
     
  • Out-of-network payments for physicians should be based on a federal standard, especially for the more than 100 million people enrolled in self-funded health plans.   

The coalition cited a recent poll from Kaiser Family Foundation which found that one in 10 insured adults said they received a surprise medical bill from an out-of-network provider in the past year.

"Patients who are doing the right thing, going to in-network hospitals, often are surprised when doctors or hospitals send them large, unexpected bills," said coalition member Annette Guarisco Fildes, president/CEO, The ERISA Industry Committee.

"Companies that sponsor health plans for their employees believe that it is imperative that we protect patients from these bills, and that we do so by eliminating the bills—not forcing someone else to pay, rewarding providers who want to charge without regard to networks, contracts or patient care," she said.

Other members of the coalition include: American Benefits Council, Blue Cross Blue Shield Association, Consumers Union, National Association of Health Underwriters, and National Business Group on Health.

"Surprise bills are an unnecessary outrage presented to families at the worst of times," said Neil Trautwein, with the National Retail Federation. "The solution to surprise billing is not to shift the bills to employers or insurers. That will only increase costs for the families we cover, a fresh outrage no one can afford."

Legislation addressing surprise billing may be one of the few issues that has support from both sides of the aisle in what is expected to be a deeply divided Congress next year.

Members of the bipartisan Senate health care price transparency working group in September released draft legislation that they said was "intended to jumpstart discussions in Congress about how to best stop the use of balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility."

The Senate group cited egregious examples of patients slapped with surprise medical bills, a bill of nearly $109,000 for care after a heart attack, and a bill for $17,850 for a urine test.

"Patients should have the power, even in emergency situations when they are unable to negotiate," said Sen. Bill Cassidy, R-LA, a physician and member of the working group.

"Our proposal protects patients in those emergency situations where current law does not, so that they don't receive a surprise bill that is basically uncapped by anything but a sense of shame."

Providers Blame Coverage Gaps

On the provider side, American Hospital Association President and CEO Rick Pollack and the Federation of American Hospitals President and CEO Chip Kahn issued a joint statement Monday insisting that hospitals, patients, insurers and employers agree that "a common ground solution" is needed to eliminate surprise bills.

However, the two hospital association leaders said the blame falls on health insurers.

"Inadequate health plan provider networks that limit patient access to emergency care is one of the root causes of surprise bills. Patients should be confident that they can seek immediate lifesaving care at any hospital," they said.  "The hospital community wants to ensure that patients are protected from surprise gaps in coverage that result in surprise bills, and we look forward to working with policymakers to achieve this goal."

Earlier this month, the AHA and the American Medical Association this month joined with AHIP to produce a consumer guide against surprise billing, and those groups are urging hospitals and other providers to make the guides available to their patients.

“Surprise bills are an unnecessary outrage presented to families at the worst of times.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Coalition calls for federal legislation to curtail surprise medical billing.

Federal standard needed for out-of-network physician payments.

Surprise billing laws may enjoy rare bipartisan support in an otherwise deeply divided Congress.


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