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Ideas To Curb Surprise Medical Bills Percolate With Rare Bipartisan Push

Do you support this push to curb surprise medical bills? Which remedy do you favor?

by Kaiser Health News | Updated on 2.5.19

Surrounded by patients who told horror stories of being stuck with hefty bills, President Donald Trump recently waded into a widespread health care problem for which almost everyone — even those with insurance — is at risk: surprise medical billing.

Trump’s declaration that taming unexpected bills would be a top priority for his administration echoed through the halls of Congress, where a handful of Republican and Democratic lawmakers have been studying the problem the past couple of years.

The sudden presidential interest has lawmakers on both sides of the aisle expressing optimism about attacking a problem that has affected 57 percent of American adults, according to a University of Chicago survey conducted last summer. Sen. Lamar Alexander, the Tennessee Republican who chairs the influential Health, Education, Labor and Pensions Committee, recently told reporters that he expects to see surprise billing legislation “in the next several months.”

Alexander is encouraged by the movement on both sides of the aisle, said a committee spokesman — giving a particular nod to the efforts of Sen. Bill Cassidy (R-La.). “The chairman looks forward to reviewing their work and hopes it leads to a bipartisan consensus on how to address the issue,” the spokesman added.

“Indications in Congress have always been that this would be something they could do on a bipartisan basis,” said Paul Ginsburg, a health economist at the Brookings Institution, a D.C.-based think tank.

Attention to this practice, which involves charging patients for care that is more expensive than anticipated or not covered by their insurance, has grown following an ongoing Kaiser Health News-NPR “Bill of the Month” investigation into medical billing at large.

While appetite for policymaking is on the upswing, the details of a possible solution remain up in the air.

The Trump administration has not laid out precisely how it would take on surprise bills. But key lawmakers, including Alexander and Cassidy, have met with administration officials to discuss how to reduce health care costs.

With an eye toward drafting legislation, these two senators and several others have been consulting with billing experts, as well as state and local officials, about the biggest challenges and most promising approaches being used around the country.

And, though Senate Majority Leader Mitch McConnell (R-Ky.) has yet to address the issue, House Speaker Nancy Pelosi (D-Calif.) said it would be a priority.

“Ending surprise billing is an important part of Democrats’ ongoing effort to lower out-of-pocket health costs, and we’ll be working on it in the coming Congress,” said Henry Connelly, a Pelosi spokesman.

Previously introduced bills would impose new notification requirements, as well as limitations on what doctors and hospitals might charge patients. They would regulate bills for either emergency care at an out-of-network facility, or non-emergency care when the facility is in-network but the doctor is not.

  • A draft bill pushed by Cassidy — a gastroenterologist by trade and the leader of a small, bipartisan group of senators studying the issue — would cap what patients pay, and prohibit balance billing, when a patient is expected to make up the difference between what the provider charged and what the insurer paid. Instead of arbitration, the state would set the amount a health plan must pay. In the absence of a local policy, health plans would default to a federal formula outlined in the bill. (This is similar to laws passed in California and Connecticut.)
  • A bill from Sen. Maggie Hassan (D-N.H.) would tackle the issue by preventing a hospital, physician group or other medical provider from charging patients more for an emergency procedure than they would have expected to pay for in-network care. It would then establish an arbitration process to determine what the patient’s health plan should pay. (This is similar to laws passed in New York and New Jersey.)
  • A bill from Rep. Lloyd Doggett (D-Texas), the chairman of the House Ways and Means’ health subcommittee, introduced during the last Congress with Sen. Sherrod Brown (D-Ohio), would require hospitals to notify patients whether they, and the doctors and other providers the patient would see there, are in-network, as well as how much patients could expect to pay out-of-pocket. Without at least 24 hours’ notice and the patient’s consent — or if the patient was receiving same-day, emergency treatment — the hospital would be able to charge the patient no more than an in-network provider would.

To draw attention to the issue, Hassan planned to bring a guest to Tuesday’s State of the Union address who was billed more than $1,600 for a trip to an in-network emergency room. The patient learned after the fact that the doctor she briefly saw there was out-of-network.

“There does seem to be across-the-board understanding that what’s happening to patients right now isn’t right or fair,” Hassan told KHN.

Other members of Congress, including Sen. Amy Klobuchar (D-Minn.) and Sen. Tammy Baldwin (D-Wis.), will bring guests with painful, personal stories regarding the high cost of prescription drugs.

For its part, the administration says its commitment to addressing surprise medical bills is firm.

“President Trump has identified surprise medical bills as a serious concern of the administration. Protecting patients from these outrageous and unexpected bills and charges is a top priority for Secretary [Alex] Azar,” said Caitlin Oakley, a Department of Health and Human Services spokeswoman.

Hassan said she has not heard anything from the White House. But as Congress shifts its focus away from the partial government shutdown, she predicted, surprise billing could emerge as a legislative priority, adding that she and Cassidy have coordinated on the issue.

Both Hassan’s and Cassidy’s bills “would go a long way toward protecting patients,” suggested Zack Cooper, a Yale health economist who researches surprise billing. Hassan’s legislation, he said, has the additional benefit of likely bringing down health care costs.

“There are a lot of issues that can’t be fixed or at least can’t be fixed easily. This is an issue that causes immense pain and is quite visceral and can be fixed,” Cooper said.

And federal legislation is likely necessary, experts say. Some states have passed laws meant to curb surprise billing, and to protect patients from the costs — but those laws don’t affect self-insured large employers, which fall under federal jurisdiction and affect more than 60 percent of people who get insurance through work.

The presidential bully pulpit could be hugely influential — in particular, Ginsburg suggested, by “leaning on Congress” to bring legislation to Trump’s desk.

And new legislation probably is the most effective vehicle, health policy experts said. It’s unclear whether or what kind of executive action HHS could take without Congress.

“Some creative lawyers could come up with creative interpretations [of existing laws] and lead to smart policy,” said Barak Richman, a Duke University law school professor who focuses on health policy.

But re-interpreting federal law would almost certainly invite legal challenges, he added.

Already, competing industry groups are lobbying to put their stamp on any federal policy. The emergency physicians’ trade group has backed an approach like Hassan’s, while the insurance lobby is calling for a Cassidy-style bill. When asked about the industry’s response, Hassan said she has gotten “a variety of feedback — as you would expect.”

Kaiser Health News

Written by Kaiser Health News

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(35)
  • Jennifer
    Voted Support
    02/05/2019
    ···

    A rare instance where legislators on both sides of the aisle could come together for the good of the country. WOW. I wasn’t sure it was even possible anymore. In fact even with Trump’s name on the post 100% of Countable participants, thus far, are in agreement. Holy Crap...has hell frozen over? Maybe with a little less resistance, solutions to real-life problems could be found, because it is my experience that the truth—and solution—is often found, not in the extreme, but in the middle.

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  • Sandra
    02/05/2019
    ···

    I worked as a Medical Assistant for years....one day, I removed stitches a few days after a knee arthroscopy....I marked "suture removal" on the billing sheet...Our biller tracked me down and asked "how many sutures:...I replied, "Three...why does it matter?" She replied, "We can charge $100 per stitch"...I was flabbergasted...."Why so much?"....She replied, "Insurance will pay 1/3 of what we bill, so, if we want $33, we bill $100".....AND, if someone else paid cash ....."cause they didn't have insurance thru work or couldn't afford insurance, THEY had to pay $100!....Affordable insurance for everyone is only part of the answer....along with that, I submit, there should be medical billing reform.

    Like (10)
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  • Leon
    Voted Oppose
    02/05/2019
    ···

    How about estimates that are binding? All inclusive no extras.

    Like (2)
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  • Joel
    Voted Support
    02/05/2019
    ···

    I don’t think anyone in their right minds supports making people broke because they are sick.

    Like (8)
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  • Wez
    02/07/2019
    ···

    If they don't send you the bill within 6 months of the visit you shouldn't be required to pay.

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  • Laurie
    Voted Support
    02/05/2019
    ···

    I prefer Universal Healthcare No surprises if we can all afford an illness

    Like (8)
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  • Myrick
    Voted Support
    02/05/2019
    ···

    Healthcare for all i mean great healthcare like Congress gets we are US citizens by God treat us as such

    Like (6)
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  • jlauer
    Voted Support
    02/05/2019
    ···

    This is a step in the right direction. Our primary issue isn’t how to pay for procedures - it’s how much they cost. Just looking at the markup on Tylenol given in hospital vs. the cost to purchase from the store is staggering.

    Like (5)
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  • Ken
    Voted Support
    02/05/2019
    ···

    I support a complete radical healthcare insurance reform. This private for profit industry does an extremely poor job of curbing cost because it cuts down on profit. For instance, I have a new medicare plan as of January. I have to have an in network doctor. Blood tests may or may not be covered. Services that are combined with specialists may or may not be covered, etc. etc. etc. I spend hours calling and trying to verify best options before seeing a doctor only to find out that advice given to me was incorrect. This day to day routine makes one feel very insecure about one's coverage. I'm sure millions of people are in my boat. ANSWER: Get for profit out of healthcare insurance! Also: Get politicics out of health care!

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  • Lionman
    Voted Support
    02/05/2019
    ···

    This is a subject that has a great deal of bipartisan support. The two sides will likely want to go about it differently, but this should be much, MUCH easier to compromise on, than most things we have in the forefront of the American mind. Healthcare costs, overall, are too darn high! They have to come down, come hell or high water.

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  • Leslie
    Voted Support
    02/06/2019
    ···

    Why doesn't AMERICA TALK TO OTHER COUNTRIES THAT HAVE UNIVERSAL HEALTHCARE LIKE CANADA? OBVIOUSLY THEY HAVE BEEN DOING IT FOR YEARS AND IT'S WORKING. DON'T BELIEVE THAT CRAP THE RIGHT WING KEEPS REPEATING ABOUT IT TAKING MONTHS TO GET A DOCTORS APPOINTMENT, THAT IS ANOTHER LIE DUE TO THE FACT THAT BIG PHARMA DONATES MILLIONS TO THEIR CAMPAIGNS.

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  • Mary
    Voted Support
    02/05/2019
    ···

    I am now in possession of a balance billing of $5,700 for radiation therapy. I believe this is due to several factors- lack of coordination between the hospital campus where the treatment was performed, the hospital maintaining the satellite practice which performs the radiation on campus, lack of communication of this to the patient and an error by the insurance carrier’s service center in interpreting the benefit provisions together with obstruction of a claim appeal - lack of transparency. I don’t think this is uncommon and refer to something as simple and common as the services provided in an emergency room by ancillary physicians. Cassidy’s bill would go far in solving this problem. Define the allowable charges for a service and disallow balance billing. This would also address one of of the drivers of healthcare inflation and rate increases- arbitrarily increasing the cost of services.

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  • Dawn
    Voted Support
    02/05/2019
    ···

    Two things I can think of off the top of my head that would help this problem immensely: 1. Require insurance companies to cover all doctors affiliated with a covered hospital. If I go to the ER at a covered hospital, there should be NO possibility that I will be seen by a doctor that isn’t considered in-network by my insurance. If the hospital is in-network, every doctor that works there should be in-network. 2. The hospital should do all billing for care received in that hospital. A trip to the ER shouldn’t result in 10 separate bills that are all due within 30 days, or who all want minimum of $100 per month payments. I should get one bill from the hospital, and one payment arrangement. Stop this mess of patients getting one bill from the emergency room, one from the trauma doctor who evaluated them, one from the imaging department who did the MRI, one from the radiologist who interpreted the MRI, one from the lab who processed bloodwork, one from the microbiologist who interpreted the results, one from the urologist who consulted when the radiologist confirmed kidney stones, and so on. ONE BILL from the hospital who, in turn, pays everyone.

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  • Jennifer
    Voted Support
    02/05/2019
    ···

    Personally, I support healthcare for all. It’s less complicated and more just.

    Like (4)
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  • Jeffrey
    Voted Support
    02/05/2019
    ···

    GENTLEMEN THIS IS TOO EASY...it’s low hanging fruit so get this done now! It time for all of you to TAKE ON THE INSURANCE LOBBY AT ALL LEVELS NOW! We are being crushed by the pricing for medical treatment and since NOBODY wants to take on the health insurance lobby and interests not to mention the multi billion dollar health care system in the US, this small entrance into the conversation should be easy to accomplish and achieve...GET IT DONE NOW!!!

    Like (4)
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  • Rodney
    Voted Support
    02/05/2019
    ···

    Yea

    Like (3)
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  • G
    Voted Support
    02/05/2019
    ···

    IT IS ABOUT DOGGONE TIME!!!! I believe the only reason this is happening is because people are pushing for single payer system. This is a good endeavor in the interim, but single payer is the mandate! See what voting for Democrats can do?

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  • Linda
    Voted Support
    02/05/2019
    ···

    Your dr.’s office is one of the only places you will go to that you have absolutely no idea how much you will get a bill for. Whether a person has insurance or not, you don’t know what is going to be covered, how much is going to be covered and how much you will be in for out of pocket whether or not the deductible, co-pays or other “out of pocket” expenses are covered.

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  • Simon
    Voted Support
    02/06/2019
    ···

    This is a step in the right direction.

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  • K
    Voted Support
    02/05/2019
    ···

    Universal healthcare

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  • Linda
    Voted Support
    02/06/2019
    ···

    Yes i approve of all of these bills. Surprise medical bills must be stopped. Everyone should know if their doc, hospital, or treatment is in net work or is covered. The price of health care must come down. As should out of pocket expense.

    Like (1)
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