Surprise Medical Bill House Panel

You went to the emergency room with chest pains, only to discover you were in the throes of a heart attack. A month or two later, you almost suffer another heart attack when you start receiving “surprise bills” from cardiologists, radiologists, and anesthesiologists that were not in-network and that charge a great deal for their specialized services. That type of incident — and the resulting “surprise billing” — was actually the topic of a recent panel in the House of Representatives.

Surprise Medical Bills

The term “surprise medical bill” typically refers to a bill that you receive as a result of seeing an out-of-network medical provider. In such instances, you are responsible for paying the difference between the original amount charged and what your insurance has agreed to pay for out-of-network medical care. That difference is usually far more than what the average person can pay. The major issues with surprise medical bills lie in the fact that patients are caught in a difficult position when they have to pay for out-of-network services for which they had no choice. One common case is emergency care where patients have no say in which doctors treat them and out-of-network doctors are free to charge a significant amount for their services.

Committee Hearing on Surprise Medical Bills

House of Representatives

On April 2 of this year, the Committee on Energy and Commerce within the House of Representatives held a legislative hearing on the subject of surprise medical bills. The committee felt strongly that patients’ bills should be limited to their in-network copays when emergency services are involved, and the goal of the hearing was to develop potential solutions to this pervasive problem.

Specialists and Surprise Medical Bills

The committee pointed to medical specialists who provide their services to hospital emergency rooms as a major issue in the problem of surprise medical bills. Such medical professionals know that their services will remain in demand even if they do not join a network, thus they have no incentive to accept hospital terms and negotiated contract rates that will limit what they can be paid for their services.

Healthcare specialist

According to the committee, common sense dictates that all the emergency services (including aspects such as radiology and anesthesiology) offered by the hospital under one roof should all be in-network. If hospitals would enforce such a requirement, then the costs for such services could be bundled together and remain in-network for the patient.

Bundled Payments as a Solution

The goal of some legislators is to see hospitals negotiate with specialists to convince them to join a network, essentially insisting that they join if they want to practice at the hospital. The patient then receives a bundled bill where all costs are considered in-network and there is a single balance for them to pay that covers all the treatment they received. The patient would be charged by the hospital, and the hospital, in turn, would be responsible for paying the specialists. All the patient would be responsible for is their in-network copay, and their insurance would cover the rest.

Resistance to Bundled Payments

Medical procedure

Three major trade groups representing hospitals (the American Hospital Association, the Federation of American Hospitals, and the American Medical Association) responded to suggestions from the committee and their response was not favorable. Hospitals are strongly resisting the use of bundled payments as a solution to surprise medical bills.

One concern expressed in a letter to the Committee on Energy and Commerce is that the bundled payment proposal as described has not been sufficiently field-tested in hospitals to prove that it is an effective solution, especially for emergency room medicine. Another weakness in the proposal, according to hospital representatives, is that the bundled payment solution essentially shifts the development of comprehensive provider networks from insurance companies to hospitals. This shift would result in hospitals assuming a financial risk that they do not believe is theirs to bear.

doctor

In the same letter, hospital representatives acknowledged the problem of surprise billing and indicated their support for finding a robust solution. They believe that solutions should focus on protecting patients from the shortfalls of insurers while still achieving a fair payment system from the insurance company to the provider.

Conclusion

Surprise medical bills are a formidable issue for many Americans, and it is not something that having insurance can protect them from. The House panel that met on the subject of these surprise bills proposed a bundled payment solution, where the hospital sends one bill for all treatments received and agrees to accept in-network amounts from insurance. Hospitals made their displeasure at this proposal known, citing the negative impact it would have on them and the yet unknown impact it could have on patients, but insisted that they do want to see patients treated fairly.

Consumer Medical Bill Solutions

If you have received one of these “surprise medical bills” then you know how overwhelming it can be just looking at that balance. Medical debt is scary. If you are feeling overwhelmed by your medical debt and would like some help getting it down to a manageable amount, contact Consumer Medical Bill Solutions today. We can help reduce your medical debt by 25% to 45% (sometimes up to 75%), and that includes both network and non-covered expenses like surprise bills. We will negotiate on your behalf to reduce your overall medical debt, stop the collection efforts against you, or eliminate the risk of balance billing. Contact us today!