Compliance News | May 10, 2019
On May 9, 2019, President Donald Trump held an event at the White House during which he called upon Congress to take action to address the issue of surprise medical bills. Surprise medical bills are sent to patients either by out-of-network hospitals for emergency room care or by out-of-network professionals providing services at in-network facilities. These bills reflect the charges remaining after the individual’s health plan has paid its share, in a practice known as “balance billing.”
At the event, the president discussed his administration’s basic principles for legislation addressing surprise medical bills. He stated that no patient should receive a balance bill for emergency room services, and he called for an end to balance bills from out-of-network professionals that patients did not choose to provide their care. He also called for better information to be given to patients when medical care is scheduled in advance, so that they will know up front whether the providers are in in their network and what this care is going to cost them. The White House released a fact sheet outlining these principles.
As the president acknowledged, there is broad bipartisan support in Congress for legislation to address surprise medical bills. A bipartisan effort, led by Senators Bill Cassidy (R-LA) and Margaret Hassan (D-NH), has been underway for some time. It is expected to result in legislation in the coming weeks. On May 9, key committees in the House (Energy & Commerce) and Senate (Health, Education, Labor & Pensions) released statements expressing their commitment to work on bipartisan legislation to address this issue.
While there is broad support for the principles articulated by the president, there is one key issue where views among stakeholders diverge: how to bridge the gap between the charges billed by the facility or professional and what the patient’s health plan is willing to pay. Some support an arbitration process to resolve these billing disputes, while others would like Congress to establish a payment rate (for example, based on a percentage of what Medicare pays or a multiple of in-network rates).
With the White House supporting the effort to address surprise medical bills, the chances for enactment of legislation have increased.
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