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Bipartisan Proposal to Protect Patients from Surprise Medical Bills

Draft legislation proposes to enact patient protections against surprise medical billing, or charges that are unexpected due to limited transparency and out-of-network care.

surprise medical bills

Source: Thinkstock

By Sara Heath

- A bipartisan group of senators have banded together to propose draft legislation that, if passed, could address the growing issue of surprise medical bills and their impacts on patient healthcare costs.

The bill, co-sponsored by Senators Bill Cassidy, MD (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO), aims to put restrictions on surprise medical bills for out-of-network physicians.

Surprise medical bills are a set of unexpected charges incurred by the patient. Patients may face surprise medical bills when they receive care in an out-of-network facility, undergo a procedure they did not know was not covered by their health plan, or receive treatment from an out-of-network clinician.

This most recent legislative proposal addresses situations in which patients receive emergency care in out-of-network facilities or from out-of-network providers. It also considers non-emergency treatment a patient receives after initial intervention from out-of-network providers.

These issues are especially common for patients receiving care in the emergency department (ED) because hospitals will often contract out work in the ED to ensure adequate staffing in all specialties at all times.

READ MORE: 67% of Patients Worry About Surprise Medical Bills, Healthcare Costs

These practices can leave patients with thousands of dollars in ED and other hospital bills, the bipartisan group noted.

The bill would require better transparency when patients receive care from an out-of-network provider in an in-network facility. Should the patient receive treatment from this clinician, the patient may only be charged their health payer co-payment.

The clinician may not charge the patient directly; instead, clinicians must negotiate with healthcare payers, who may either pay the clinician the median charge for in-network care for that service or 125 percent of the average price in that geographic region.

The legislation calls for similar protocol when a patient receives emergency treatment in an out-of-network facility by an out-of-network provider.

The draft legislation also offers protections for patients receiving non-emergency care following emergency treatment at an out-of-network provider. The draft legislation calls for better healthcare transparency notifying the patient of the potential additional charges; in some cases, written patient consent may be necessary.

READ MORE: Complex Health Plan Benefits Give Rise to Surprise Medical Bills

This legislation offer protections to help put patients back in control of their own healthcare, according to Senator Cassidy.

“Patients should have the power, even in emergency situations when they are unable to negotiate,” Cassidy said in a statement. “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.”

The linchpin of the legislation is the heightened level of healthcare transparency, added Senator Bennet.

“Increasing transparency is one of the most important steps we must take to improve our health care system,” said Senator Bennet. “Patients deserve to know how much they are paying for health care services and procedures at the point of care. I’ll keep working with my colleagues to find bipartisan solutions like this to lower costs and improve patient care.”

Surprise medical bills are a growing issue in the healthcare industry, separate reports have indicated. Sixty-seven percent of patients are worried about surprise medical bills, calling into question healthcare price transparency practices, according to recent data from the Kaiser Family Foundation.

READ MORE: Top Strategies for Collecting Patient Financial Responsibility

The survey of 1,200 adult patients found that 58 percent are concerned about overall growing healthcare costs. Thirty-eight percent of respondents reported that they are very concerned and 29 percent said they are somewhat concerned about surprise medical bills. Only 16 percent of patients said they are not at all worried about surprise medical bills.

Unexpected bills proved an even larger concern than high premiums (18 percent), high deductibles (24 percent), and rising drug costs (22 percent).

Worries about surprise billing are substantiated by the high number of patients receiving surprise medical bills. Forty percent of the surveyed population had received a surprise medical bill within the past year. And while most of these surprise bills totaled to less than $500, some patients saw exceptionally high charges.

Sixteen percent of respondents reported unexpected bills reaching up to $999, 12 percent received a bill between $1,000 and $1,999, and 13 percent were billed over $2,000.

This latest legislative proposal, if passed, would be the next step in preventing patients from taking on such high medical costs, said Senator Carper.

“No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency,” Carper stated. “The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider.”

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