Will Congress Address “Surprise Bills” in Health Care?

• January 28, 2019
• Jennifer Boese

Surprise bills, also referred to as balance billing, is when a consumer (ie: patient) seeks medical care at a hospital or from providers he/she believes are in-network only to receive a bill for the balance of the cost because somewhere along the line a provider was out-of-network. (To read about a few examples, see Sarah Cliff’s series.) I do think the tide is turning nationally, and that Congress will tackle this issue in the 2019-2020 session.

Let’s look at a situation where a patient needs surgery. She researches the hospital and surgeon, doing her best to make sure they are all in-network. Unbeknownst to her, the anesthesiologist or pathologist used was out-of-network. The patient later receives a large “surprise bill” for the balance of that cost. In some situations, this can lead to a negotiating stand-off between the insurer and the hospital/provider. The patient – with the least ability to pay and the least negotiating power – is left in the middle, financially on the hook.

A few states, like Florida, California and New York, have enacted comprehensive laws to get at these situations, while some states have smaller policies in place. The majority of states do not address the issue at all, which may be why bipartisan members of Congress released draft legislation last year and the President has taken in recent days to speaking about the need to fix this issue.

What are some of the policies that have been proposed or even enacted at the state level?

• Establishing fixed charges in these situations (say, Medicare + X%);
• Capping a patient’s financial liability;
• Creating an arbitration process;
• Exempting certain services (say, emergency or sexual assault); and,
• Requiring more transparency, notice of providers in/out of network.

In a time period of political polarization, addressing the issue would demonstrate Congress can take on health care issues (top of mind for many constituents) and effectively legislate in a bipartisan fashion. Win-win in the legislative world as well as a win for consumers. That’s why I expect legislation will be re-introduced in this Congress and that it has a better-than-average shot of passage. What do you think?

, Health Care General, Health Care Policy | 1 Comment »