Few visits to the hospital come, according to increased numbers of patients, without a few unexpected fees attached. Surprise medical bills — those unexpected, hidden and quite expensive charges patients face that insurance companies deny – have become so overwhelming that Congress has decided to step in to address them.

A recent Kaiser Family Foundation report illustrates the risks emergency room and hospital patients face from surprise medical billing, finding that in 2017, approximately 1 in 6 of these patients had at least one out-of-network bill associated with their care. In some states, the rate of surprise billing was closer to 1 in 3 patients.

In a bill introduced by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash), new rules would eliminate surprise medical bills, as well as work to: (1) reduce prescription drug prices; (2) improve transparency in health care; (3) improve public health; and (4) improve the exchange of health information.

The Lower Health Care Costs Act of 2019 would set out specific protections for patients who are at risk of surprise bills in the following scenarios: receiving emergency care from an out-of-network facility or provider; getting elective care from an out-of-network doctor at a facility that is in the patient’s insurance network; or receiving additional, post-emergency health care at an out-of-network facility because the patient cannot travel without medical transport.

“First, it ends surprise billing. Second, it creates more transparency— there are twelve bipartisan provisions that will: eliminate gag clauses and anti-competitive terms in insurance contracts, designate a non-profit entity to unlock insurance claims for employers, ban Pharmacy Benefit Managers (PBMs) from charging more for a drug than the PBM paid for the drug, and require that patients receive more information on the cost and quality of their health care. You can’t lower your health care costs until you know what your health care actually costs,” Alexander said. “And third, it increases prescription drug competition—there are fourteen bipartisan provisions to help more low cost generic and biosimilar drugs reach patients.”

According the Coalition for Fiscal Health, charges have gone from bad to astronomical in only a few short years. They report one patient being charged $117,000 for an “assistant surgeon” fee, and another being billed nearly $1700 for a single dab of glue following a procedure.

The protections would mean that people in these situations could not be billed by their health providers for amounts outside of what their insurance covered. Similar protections would also be put in place for laboratory and imaging services as well as providers who aren’t physicians, such as nurse anesthetists.

Patients would still have to pay their insurance plan’s usual deductibles and copayments, which would count toward their health plan’s out-of-pocket maximum.

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WI Guest Author

This correspondent is a guest contributor to The Washington Informer.

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