Many of us have felt shock and dismay at opening a medical bill we thought our health insurance had covered only to discover that we owe an outstanding balance. Often, the amount still due is beyond anything we can manage to comfortably pay. Surprise medical bills appear in American mailboxes and email every day and usually include a list of exorbitant charges. Now, a bipartisan group of senators is working to stop those unexpected, excessively high bills from ending up in patients’ hands.
On September 18, a number of senators unveiled a plan to protect patients from surprise bills and high charges from hospitals or doctors who are not in their insurance networks. The legislation, they hope, will prevent medical bankruptcies and protect patients with health insurance from paying ridiculous amounts of money to hospitals, doctors and other healthcare providers and facilities.
Three Main Concerns of Surprise Medical Bill Legislation
The proposed bill addresses three core problems with surprise billing:
- Emergency services provided by an out-of-network facility
- Non-emergency services after emergency service from an out-of-network facility
- Non-emergency services by an out-of-network provider at an in-network facility
First, legislation would prevent hospitals from balance billing in emergent situations; balance billing is the term used to describe the charges/balance left after the health insurance company has paid its part. The new legislation says that a hospital cannot bill you for services not covered by your insurance company; only the insurance company can continue to be billed to collect outstanding balances. Specifically, “…the hospital and doctor could seek additional payments from the patient’s insurer under state regulations or through a formula established in the legislation.”
This would protect people from receiving exorbitant medical bills for medical services performed during an emergency that were not covered by their health insurance. Millions of Americans each year received (and many pay) medical bills that they have no business being help responsible for, and this new legislation hopes to end that unfair billing practice.
Second, if you require non-emergent follow-up care after you have received emergency services from an out-of-network hospital, you must be told that you could be responsible for charges if you elect to receive follow-up care at an out-of-network facility.
Third, (and maybe most common) is that medical providers who work together in hospitals are not always on the same network as the in-network hospital. If a certain hospital is “in network” for you but the anesthesiologist providing anesthesia during your surgery is “out of network,” you can be billed for those out-of-network services according to how the legislation stands now even though you found out prior to your surgery that your hospital was in network.
Sponsors of the proposed legislation include Senators Bill Cassidy (R-La.): Michael Bennet (D-Colo.); Chuck Grassley (R-Iowa); Tom Carper (D-Del.); Todd Young (R-Ind.) and Claire McCaskill (D-Mo.).