Fight to end surprise medical bills goes national

Geraldine Slevin
Assistant Policy Analyst

Tuesday, November 3rd, 2015

As more states pass protections to end surprise medical bills, Congress is getting in on the act. In October Congressman Lloyd Doggett of Texas introduced the “End Surprise Billing Act of 2015,” landmark legislation that would go a long way toward ending surprise bills for all Americans.

The measure would require hospitals and medical facilities to first get your consent if you are treated by someone who is not in-network on your insurance plan. If such consent is not possible—for example, in emergency situations—you would pay only what the facility would have paid for an in-network provider.

“Consumers shouldn’t be the losers in the billing tug-of-war between doctors and insurers,” says Betsy Imholz, Special Projects Director for Consumers Union.. “This legislation is an important step in taking the ‘surprise’ out of surprise medical bills and ensuring that consumers aren’t on the hook for unexpected charges, especially in emergency situations.”

Our 2015 survey found that nearly one third of privately insured Americans had received a surprise medical bill where their health plan paid less than expected in the past two years. Among respondents, nearly one in four received a bill from a doctor they did not expect to receive a bill from.

These results – and thousands of stories from consumers who’ve been hit with unfair, unexpected bills – led us to launch our End Surprise Medical Bills campaign to put an end to these bills for good.

We’re already working in several states, including California, Texas, New Jersey and Pennsylvania, to pass legislation to strengthen protections against surprise medical bills. With the introduction of this new federal bill, legislators across the country are paying attention, and will be pushing Congress to get this legislation passed.

Now we need your help to keep up the momentum and spread the word. You can visit our  campaign homepage to share your surprise medical bill story, sign our national petition, or use our Insurance Complaint Tool to get help with a bill and find resources specific to your state.

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7 responses to “Fight to end surprise medical bills goes national”

  1. Mark Owen says:

    Most if not all out of network bills that are unexpected by the patient or guarantor stem from an in-network hospital visit where one is often treated by multiple physicians some of which one did not or could not have known would be asked to see the patient prior to the initial exam. In the case of elective hospital visits, one that is scheduled, usually by your primary care physician one must ask, should the in-network primary care Dr. referring the patient be required to get the “estimate” for the patient prior to the visit. As an in-network preferred provider with a contractual relationship with the patient’s insurance shouldn’t the referral be a guarantee that wherever the patient is sent all of the care will be treated as in-network services? If the visit is not elective then it is an emergency. The prudent layperson definition says that anyone with a reasonable knowledge of health that believes they have an emergency must be seen in the emergency department. Being a prudent person the patient may know which hospital nearby is in network if the injury or illness happens close to home, but even in that case, if picked up by EMS the EMS driver must take the patient to the nearest emergency department not the one that could be a block further and in network. You can begin to see all of this is complicated and these are just some of the variables. So you get to the in network emergency with your ruptured appendix, the in network ER Dr. works you up and the in network admitting Dr. writes the orders for an emergency appendectomy. The radiologist is in network, but you knew that from your prior research months ago when you changed jobs and got a new insurance company with a different network. However, since your research the anesthesia group was dropped from the network. Also, being an emergency surgery the surgeon on-call turns out not to be in-network either. The pain killer drugs were started in the emergency room, any delay in surgery means a greater risk of peritonitis; are you in any condition to deal with the news that two of your Drs. are not in network? Now, sure the easy fix for the patient is require that the patient cannot be at risk for any more than in network costs. However, this creates very dangerous economic problems for Drs. that will eventually affect all hospital patient care adversely. This would mandate that the insurance companies can “fix” the rates they pay Drs. without regard to fair reimbursement. Insurance companies cannot be allowed to fix Drs. rates unilaterally or we risk major quality of care and access to care issues in the future. How can we protect the patients from unexpected out of network charges and ensure a level playing field where providers can receive fair compensation from third party payers? Payers that currently control the market because they hold the premiums intended to pay for the services rendered and the providers have no reasonable recourse? Emergency providers that must provide services without regard to whether they will ever be paid. One way is to mandate a minimum emergency provider payment that is fair and reasonable as determined by all parties equally.

  2. Linda R. says:

    As one who is a “victim” of out of network misrepresentation I would like to see one fee for all and none of this war of the prices.
    This bill is a beginning but not really what we need. All human beings in America should know ahead of their appointments, visits, emergencies how much it’s going to cost them just like going to a restaurant. And I shouldn’t have to make 50 million calls before hand to find out nor have to rely on an Internet connection

    • Kendall says:

      I agree, but would argue its closer to going to a mechanic than a restaurant (or a combination of the two). A mechanic cant tell you total cost upfront but they can (and in most cases I believe) must give you transparent rates and costs. You can then take this and compare it to other mechanics.

      Hospitals should have to show their market rates, and give estimates based on averages. Here is what the average bill is for X procedure, and here are the rates for costs that may raise or lower that bill.

      In emergency situations this information may come after the fact (or bill) but it can be used even then to give transparency, and lend leverage to the patient for price negotiations.

      • Consumers Union says:

        Hi Kendall – thanks for your reply. That’s a great analogy for the problem – consumers need more information so they can make informed choices in addition to protection from unfair bills.

    • Consumers Union says:

      We agree that consumers shouldn’t have to spend hours calling around to make sure they don’t end up with an out-of-network bill. If you haven’t already, please share your surprise bill story with us here!

      • The real issue is our fee-for-service system. We should have a single-payer system. Failing that, the next layer of problems
        lies in a layer further down: the existence of these medical networks.

        A. Any bill for medical services should at minimum include IN EVERYDAY ENGLISH AND FULLY SPELLED OUT:
        1. The names, professional credentials, and connection with the place of service for every provider.
        2. The name, date, time, location, and brief description of each procedure.
        3. A brief description off the results as known at that time.

        B. Billing should be prompt and suitably sequenced: itemized fees and charges, expected insurance payments, patient liability, and payment options for the patient. Given available technology at this time, there’s no excuse for billing running days or weeks behind treatment. Maybe same day billing isn’t feasible, but I will bet any reasonable amount of money that billing within three days of service is easily doable.

        C. Payment by third party payers should be prompt. By that I mean in a day or two; no weeks or months of delays.

        D. Providers and third party payers should not be allowed to drag the patient into disputes between providers and third-party payers. Require the responsible parties to get their act together. Two days to choose, and no charge if they don’t do it on time.

        E. No lawyers!!!!!!!!!

        In summary, get it done transparently and quickly.

        YES YOU CAN. If you can’t imagine how, my consulting rate is $250/hour, payable daily.

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