A coalition of nine major organizations including the American Benefits Council, Blue Cross Blue Shield Association, Consumers Union, National Association of Health Underwriters and National Business Group on Health, has called for federal legislation to curb surprise billing—a situation that occurs, in many cases, when a patient receives care at an in-network facility from an out-of-network provider and then receives an unexpected bill for services rendered.
As evidence for the size of the problem, the coalition points to a recent study by the Kaiser Family Foundation revealing that one in 10 insured adults has received a surprise bill from an out-of-network provider in the past year.
Not surprisingly, the announcement has once again pitted insurers against providers. Though both sectors agree that patients should not be penalized, and stress their desire to find "common ground" to remedy the problem, their disagreement on the root cause leaves them pointing a finger at each other.
"Often, patients are treated in an emergency department that does not participate in their insurance network or by a specialist who does not participate, despite being at an in-network facility or doing all they can to ensure they are being treated in-network," according to a statement of principles issued by the nine-member coalition. "Patients should not be financially penalized in cases when they receive out-of-network care through no fault of their own. In these circumstances, providers should be prohibited by law from billing the patient for costs not covered by their health plan."
The AHA and the Federation of American Hospitals disagree. The two organizations released a joint statement saying, in essence, that the responsibility for curtailing surprise billing falls on health insurers.
"Inadequate health plan provider networks that limit patient access to emergency care is one of the root causes of surprise bills," they stated. "Patients should be confident that they can seek immediate lifesaving care at any hospital. The hospital community wants to ensure that patients are protected from surprise gaps in coverage that result in surprise bills, and we look forward to working with policymakers to achieve this goal."
But in a statement issued by the coalition, Neil Trautwein of the National Retail Federation countered that "the solution to surprise billing is not to shift the bills to employers or insurers. That will only increase costs for the families we cover, a fresh outrage no one can afford."
A federal solution may be on the horizon. In September, a bipartisan Senate price transparency working group introduced the Protecting Patients from Surprise Medical Bills Act to shield consumers from responsibility for large out-of-network charges at in-network facilities. Several states, including California, Illinois, Florida and Connecticut, have passed comprehensive surprise billing legislation, but many believe a federal strategy offers the best way to alleviate the problem on a larger scale.
The AHA, AMA and Healthcare Financial Management Association have published a consumer guide to protect patients from surprise billing. The groups encourage healthcare organizations to use the guide in pre-procedure communication with patients and post the information on their websites.
Hopefully, stakeholders and legislators will be able to find the common ground needed to map an effective plan forward and alleviate what has become a major source of consumer debt.