Lawmakers Propose Legislation Aimed at Addressing Surprise Medical Bills

Lawmakers Propose Legislation Aimed at Addressing Surprise Medical Bills

There is rare bipartisan momentum in support of several different pieces of legislation aimed at addressing the issue of “surprise medical bills”— exorbitantly high emergency and other medical department bills.

Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR) recently proposed draft legislation that would work to prevent patients from receiving unexpectedly high medical bills, which happens when patients deliberately choose a provider in their network but find out later they were treated by a physician that doesn’t have a contract with their payer. Vox reporter Sarah Kliff wrote extensively about these bills as part of a year-long investigation into emergency department billing.

The Pallone and Walden legislation, according to Vox’s analysis of the proposal, would require payers to treat out-of-network emergency care as in-network care for their enrollee’s cost-sharing and out-of-pocket obligations, and require insurers to make a minimum payment to out-of-network providers for their enrollee’s care, based on the price the insurer pays to nearby in-network providers. Some of Vox’s reporting has implicated the use of inappropriate emergency department billing codes as part of the problem.

President Trump has also signaled support for ending surprise billing, which boosts the likelihood of such bills to succeed.

According to the LA Times, there’s interest in the Senate to address the matter with Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) hoping to include surprise bills in a larger package of legislation that’s due to be proposed before Memorial Day. Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) have also initiated efforts in the Senate to address surprise bills.

The LA Times highlighted a surprise medical bill received by Rep. Katie Porter (D-CA) when she experienced a burst appendix while on the campaign trail. Porter made sure she was taken to a provider in her network, even though it was farther away than the closest hospital. After her copay Porter received another bill for $3,431 from the surgeon, who was operating at a hospital that was in Anthem’s (Porter’s insurer) network even though he himself isn’t part of that network.

California, New York, and other states have passed their own surprising billing laws.

Mary Butler is associate editor at Journal of AHIMA.
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