The US Senate HELP (Health, Education, Labor, and Pensions) committee has unveiled a promising bipartisan plan known as the Lower Health Care Costs Act of 2019 that aims to lower healthcare costs through a variety of reforms. This proposed legislation contains numerous medical bill reforms that could impact your healthcare costs, so it is important to get a general idea of what is contained in the legislation.
The Nightmare of Surprise Bills
Surprise bills, as they are termed, have become a nightmare for many individuals with health insurance. All it takes is one trip to the emergency room and suddenly you are expected to pay thousands of dollars out of pocket because many of the specialists who saw you during your emergency visit were not in-network — and you still are charged for their care even though you had no choice over who provided your medical services.
The US Senate HELP committee’s plan leads with strategies to effectively put an end to these surprise medical bills and thereby starts reducing medical costs for individuals with insurance. Currently, there is little to no oversight of these surprise bills.
Set Reimbursement Rate for Out-of-Network Providers
One of these strategies is to have a set reimbursement rate for out-of-network providers. This rate would be calculated based on the median contracted rate for the same type of providers in the geographic area. As it stands now, this strategy seems to strike a good balance between protecting the patients while still making sure the service providers are paid fairly.
However, there is a concern on the part of healthcare providers and some legislators that such a measure would set a dangerous precedent of allowing the federal government to interfere with the rates that medical service providers are allowed to charge.
Negotiation and Arbitration
Another strategy presented in the Lower Health Care Costs Act of 2019 allows negotiation between the medical insurer and the service providers regarding the service provider’s rates for any surprise medical bills over $750. An independent arbiter would be used to settle any dispute between the insurance company and the service provider.
Again, this approach seeks to make sure that the service providers are fairly paid while protecting patients from excessive surprise bills. There are, however, complaints that negotiations and arbitration could, in the long run, raise the cost of medical care rather than lower it.
All Providers In-Network
Also included in the Lower Health Care Costs Act of 2019 is wording that would require that all medical service providers working at a hospital be in-network: either they will join the insurance networks that already cover the hospital or send their bill through the hospital.
Of all the strategies suggested by the HELP committee, this is perhaps the most controversial. Hospital executives are concerned that this approach to ending surprise medical bills could cause a disruption to incentives for health plans to establish comprehensive networks. It is also argued that bundling payment is untested and there is no proof that it will reduce medical costs.
Other Major Issues
Surprise medical bills are not the only focus of the Lower Health Care Costs Act of 2019. Here are some other proposed initiatives that aim to reduce costs for patients:
- A means of longitudinal access to all patient data (regardless of where it originated) combined with a standardized reporting format
- Elimination of generic drug loopholes by supporting the development and marketing of biosimilar drugs
- Providers and insurers would both be required to provide cost estimates for out of pocket expenses associated with scheduled care
- Allowing patients access to their own electronic claims information
- Healthcare facilities would be required to provide a summary of services to patients after they have been discharged to help make it easier to track bills and understand what is being paid for
- Establishment of a new non-governmental, non-profit entity whose task would be de-identifying healthcare data so stakeholders would be able to access and understand healthcare costs better
- Hospital and emergency bills must be sent out within 30 business days
- Prohibition of anti-competitive terms in provider-payer contracts (including gag clauses that prevent either party from disclosing negotiated rates) as an effort towards more transparency of healthcare costs
The US Senate HELP Committee’s proposed bipartisan legislation, known as the Lower Health Care Costs Act of 2019, shows promise in reducing the costs faced by many insured individuals and includes strategies not just to put an end to surprise medical bills but also to address issues that impact the cost of healthcare and the quality of healthcare as well. However, the proposed legislation is already receiving pushback from the medical industry. Such a bipartisan effort is a good sign and gives us hope that the problem of medical debt in the US will cease to be so widespread and crippling.
Consumer Medical Bill Solutions
Consumer Medical Bill Solutions specializes in helping individuals like you who are burdened with medical debt, which sadly is an all too common problem in our nation today. Our experienced staff can help you reduce your medical debt by 25% to 45% (sometimes up to 75%) through aggressive negotiation on your behalf to reduce your overall medical debt. Our process is straightforward: fill out a contact form, talk with one of our customer service team members, sign the necessary releases, provide us with the documentation of your medical bills, and let us negotiate a settlement for you. Contact us today!