President Trump called upon Democrats and Republicans to pass legislation to end surprise medical billing in remarks delivered from the White House earlier this month. Senators from both sides of the aisle have already been working on legislation for months to ban surprise medical bills.
Surprise billing occurs when an out-of-network provider bills a patient for the difference between their billed charges and the patient’s health plan’s allowed amount (known as the “balance bill”) in situations where either (1) the patient may not have known that the provider was out-of-network with their health plan, or (2) did not have a choice in selecting their provider such as in an emergency situation.
Support for solving the problem, which can be financially devastating, is not just found among politicians and patients; out-of-network providers, employers offering a health plan to their employees, and insurance companies are all also interested in putting an end to unexpected medical bills.
Despite the broad support for solving the problem, healthcare providers and insurers are at loggerheads when it comes to actually resolving it. Healthcare providers want to be paid fairly for the services they provide to patients (in many cases, providers rendering emergency treatment had no choice but to treat a patient) and insurers want to continue paying as little as possible to healthcare providers to protect their bottom lines. The division is so great, it is unlikely that lawmakers will be able to find a compromise to satisfy all constituents.
By and large, physicians favor a negotiated-fee system for billing disputes, such as a binding arbitration, in which an independent third-party makes the ultimate payment decision. Insurers, on the other hand, favor “benchmark” payments based on Medicare rates or “median” in-network rates.
Several states have enacted surprise billing legislation with New York’s cited as one of the most comprehensive. Under the New York bill, patients are not required to pay more than they would for an in-network doctor or hospital if they have received emergency treatment or inadvertently treated with an out-of-network provider. For the remaining bill, an independent arbitrator settles any dispute between the provider and insurer.
The bill currently in play in the Senate is set to automatically encompass nearly 100% of all health benefit plans including ERISA self-insured plans (under state bills, such as New Jersey’s, health plans had to affirmatively elect to be subject to key provisions of the laws).
The bipartisan group of senators indicated “we’re getting really close to an approach” and they hope to have a bill to the President by July.