U.S. Senate Works On Legislation To Curb Surprise Medical Bills

A bipartisan Senate health care price transparency working group has released draft legislation that it hopes will protect patients from surprise medical bills.

In a statement, the group is Senators said the draft bill is intended to jumpstart discussions in Congress about how to best stop the use of balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.

Bill Cassidy (R-LA) explained that the proposed legislation was for use in emergency situations. “Patients should have the power, even in emergency situations when they are unable to negotiate. Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame.”

On the proposed legislation, Cassidy is working with Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), Maggie Hassan (D-N.H) and Claire McCaskill (D-MO). The Senators hope to release the new legislation by the end of March.

Reducing bankruptcies caused by high health bills

The Senators cited examples where one patient received a bill of nearly $109,000 for care after a heart attack because the hospital was not in his insurance network, and another who received a bill for $17,850 for a urine test.

Carper said the intention of the legislation was to ensure that no American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency.

“The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider. I’m proud to work with my colleagues on both sides of the aisle to ensure patients will have more transparency when it comes to the costs of their services or procedures,” Carper said.

In February, CNBC reported that medical bills were the biggest cause of U.S. bankruptcies, estimating that 2 million people were adversely affected.

Last year, Hassan and Cassidy’s group reportedly proposed separate bills to protect patients from surprise medical bills, but now they are working together to craft one, revised bill.

“I am pleased that we are all working together across party lines to draft a bill that will help end the absurd practice of surprise medical bills and take the patient out of the middle of these disputes,” Hassan was quoted saying.

What the draft legislation covers

According to a statement, the legislation covers three areas:

• Emergency services provided by an out-of-network provider in an out-of-network facility: The draft bill would ensure that a patient is only required to pay the cost-sharing amount required by their health plan, and a provider may not bill the patient for an additional payment. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.
• Non-Emergency services following an emergency service from an out-of-network facility: The draft bill would ensure that if a patient receives an emergency service from an out-of-network healthcare provider or facility and requires additional services after being stabilized, the health care facility or hospital will notify the patient, or their designee, that they may be required to pay higher cost-sharing than if they received an in-network service and give the patient an option to transfer to an in-network facility. The patient, or their designee, would also be required to sign a written acknowledgment of that notification.
• Non-Emergency services performed by an out-of-network provider at an in-network facility: The draft bill would ensure that a health plan or out-of-network provider cannot bill a patient beyond their in-network cost-sharing in the case of a non-emergency service that is provided by an out-of-network provider in an in-network facility. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.

President Donald Trump gave impetus to efforts to curb surprise bills by declaring that taming unexpected bills would be a top priority for his administration. Earlier this year, Trump said the pricing was hurting patients, adding “we’ve stopped a lot of it, but we’re going to stop all of it.”

Trump has also voiced his concern about the high cost of prescription drugs while House Democrats in Illinois are set to introduce legislation that will reduce the cost of medication.