Insurers and Other Groups Taking a Stand Against Surprise Medical Bills to Protect Patients

A coalition of nine groups, including insurers, businesses, and consumers, recently banded together to announce that they would be supporting federal legislation to protect patients from unexpected medical bills.

The coalition cited a poll by Kaiser Family Foundation that found that 4 out of 10 people received “a surprisingly large invoice” for a medical service within the past year. They also found that 67% of Americans are afraid they won’t be able to pay their unexpected medical bills more than they worried about paying for necessities like food, rent, or gas.

The nine groups include America’s Health Insurance Plans (AHIP), American Benefits Council, Blue Cross Blue Shield Association, Consumers Union, the ERISA Industry Committee, Families USA, the National Association of Health and of Underwriters, the National Business Group on Health, and the National Retail Federation.

According to a statement issued by the group, the main issue stems from the fact that "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 consequence is millions of consumers receiving surprise, unexpected medical bills that can often break the bank."

Many hospitals these days use something called “balance billing.” Using this system, some hospitals charge patients the difference between what the provider bills and the insurer pays for out-of-network providers.

When a patient receives emergency or non-emergency medical services from an out-of-network provider, they frequently have no way of knowing. This is especially unfair for consumers that have to pay up to tens of thousands of dollars to receive out-of-network care. That’s why, in their statement, the coalition agreed to back legislation with four guiding principles:

• Federal legislation to protect patients from surprise bills especially when it was through no fault of their own.
• Policy changes to ensure that patients are informed when care is out of network in a clear and timely manner, and written in plain language.
• 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.

In what is expected to be a deeply divided Congress next year, this is one issue that is receiving bipartisan support. The federal legislative bills that the coalition is supporting includes:

• Senator Margie Hassan (D-New Hampshire) introduced 3592, the No More Surprise Medical Bills Act of 2018. In emergency situations, out-of-network healthcare providers would not be able to charge patients more than they would have otherwise been required to pay if the bill had come from an in-network provider.
• Senator Jeanne Shaheen (D-New Hampshire) introduced 3591, the Reducing Cost for Out-of-Network Services Act of 2018, which would set limits on the amount that out-of-network providers can charge and allows states to pick among 3 options to set the limit: 125% of the Medicare fee-for-service rate, with allowances for rural areas; 80% of the usual and customary rate of the provider’s bill; or the insurers’ in-network rate for the same service. It would also set up a binding arbitration process between insurers and providers.
• The bipartisan Protecting Patients from Surprise Medical Bills Act (PPSMBA), would regulate 3 areas: emergency services provided by an out-of-network provider in an out-of-network facility, non-emergency services following an emergency service from an out-of-network facility, and non-emergency services performed by an out-of-network provider at an in- network facility.

The North Carolina Coalition for Fiscal Health will be keeping an eye on the movement of these bills and further statements by the coalition and keep you informed.

Have the sky-high costs of healthcare in our state impacted you and/or your family’s lives? Do you want to do something about it? Join the Coalition now to receive updates about new legislation and policies that will affect YOUR healthcare. Sign up now!