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Trump, Congress Look to End Surprise Medical Billings


On Thursday, May 9, President Donald Trump called for an end to 'surprise medical bills' that can cost consumers thousands ... or tens of thousands ... of dollars for out-of-network billing. Legislators in both parties agree these bills unfairly impact patients when they are at their most vulnerable - such as in the delivery of emergency care - or when they have no control over or are unaware of out-of-network use - such as going to an in-network surgeon but having an out-of-network anesthesiologist.

With bipartisan support to address the issue, lawmakers hope to have legislation in place by this summer. Below is reaction from several stakeholders and comments from Sen. Lamar Alexander (R-Tenn.), who chairs the Senate HELP committee:

Sen. Alexander:

"Ending surprise medical billing is a perfect example of how Congress and the president can work together to reduce out of pocket health care costs. Twenty percent of patients who visit the Emergency Room end up several weeks later with a several thousand dollar bill that they did not expect. I told the president today that, working with Senator Murray and other members of our committee, our goal is to have a bipartisan solution to end the practice of surprise medical billing to the Senate floor by July. I was glad to have the president say today that he supports this bipartisan effort."

Click here to view the video.

Statement from AHA President & CEO Rick Pollack:

America's hospitals and health systems are fully committed to protecting patients from unanticipated medical bills that they may incur because of unexpected gaps in their health coverage or as a result of medical emergencies. The last thing a patient should worry about in a health crisis is a surprise medical bill. The AHA commends the Administration and Congress for their work to find solutions to this problem.

The AHA has urged Congress to enact legislation that would protect patients from surprise bills. We can achieve this by simply banning balance billing. This would protect patients from any bills above their in-network cost-sharing obligations. Untested proposals such as bundling payments would create significant disruption to provider networks and contracting without benefiting patients.

We look forward to our continued work with the Administration and Congress on workable solutions to stop surprise bills.

National Business Group on Health Applauds Efforts to Protect Patients from "Surprise Billing"

The National Business Group on Health (The Business Group) applauds the President and the Administration for recognizing the need to curb "surprise billing" and Congress' efforts to find a solution that protects patients while also not raising health care costs. The Business Group agrees patients should not receive surprise bills from out-of-network providers they did not choose--whether it is for emergency care or for care they receive at in-network hospitals or other in-network facilities.

Employers cover more than 181 million Americans, and many already protect their employees and their families from surprise bills and assist and advocate on behalf of their employees to reduce or eliminate these bills when they happen1. Still, surprise bills remain a concern.

As Congress and the Administration address the issue, the Business Group, along with other employer associations, outlined a set of principles that would protect all consumers from higher health care costs and would not discourage physicians from participating in networks. The Business Group also believes that hospitals and other facilities should play a central role in protecting patients. Hospitals can reduce the likelihood that the physicians they contract with to perform core services (e.g. emergency, anesthesia, radiology, and pathology services) do not charge patients and plans who rely on their in-network status more than what they would pay in-network.

"Health care is already complicated and costly enough. Patients shouldn't be receiving surprise bills from doctors they don't choose when they go to a hospital in their insurance network or when they have an emergency," said Brian Marcotte, President and CEO of the National Business Group on Health.

Statement from Envision Healthcare on House Ways and Means Health Subcommittee Hearing on Surprise Billing

Envision Healthcare released the following statement on today's hearing, "Protecting Patients from Surprise Medical Bills", held by the U.S. House of Representative's Ways and Means Health Subcommittee.

"Envision is committed to ending the practice of surprise medical bills, which is why we have taken significant steps over the years to become 90 percent in-network, and are seeking to get as close to 100 percent in-network as possible. We are hopeful the bipartisan momentum in Washington will result in a solution that ensures doctors can continue to provide high quality care and that patients will no longer receive surprise medical bills. Envision supports a fair, market-based solution that works for all Americans, including those who rely on hospitals in rural areas. The emergency room is an essential social safety net for Americans, and one worth fighting for." - Bob Kneeley, Senior Vice President of Envision Healthcare

Statement from Patrice A. Harris, M.D., President-elect of the American Medical Association

"The American Medical Association commends Reps. Raul Ruiz, M.D., Phil Roe, M.D. and the other cosponsors of the Protecting People from Surprise Medical Bills Act for their efforts to address the impact that unanticipated medical bills can have on families. The outline released today represents a common-sense approach that protects patients from out-of-network bills that their insurance companies won't pay while providing for a fair process to resolve disputes between physicians and hospitals and insurers. We look forward to working with these members as further details emerge."

ACEP Applauds Reps. Ruiz, Roe, and Bipartisan Coalition for Protecting Patients from Surprise Bills

The American College of Emergency Physicians (ACEP) applauds the release today of the framework for the Protecting People from Surprise Medical Bills Act. ACEP strongly supports the proposal as outlined because it truly takes patients out of the middle of disputes between insurers and medical providers and implements a market-based approach to encourage these parties to set fair payments and prices from the start.

Vidor Friedman, MD, FACEP, president of ACEP said:

"ACEP is pleased that Representatives Ruiz, Roe, Bera, Morelle, Taylor, Bucshon, Shalala, and Wenstrup recognize the need for a policy remedy that more directly addresses the root cause of surprise bills - inadequate insurance networks. Patients need a legislative solution to protect them when they have surprise gaps in their expected insurance coverage, and this proposal takes critical steps to do so by encouraging more transparency from insurance companies and making sure that patients can better understand the limitations of their insurance.

The proposed approach makes certain that a patient only pays the in-network amount for emergency care, whether the care delivered was in- or out-of-network. ACEP strongly supports the proposal's provision that extends this important protection to the patient's deductible - bringing down the amount a patient must pay out of their own pocket before their insurance kicks in. This key provision will encourage health plans to expand their networks for emergency care; addressing the root cause of "surprise bills," narrow insurance networks.

In addition, this proposal calls for 'baseball-style' arbitration to ensure a fast and fair resolution of any billing issues between insurers and providers. This simple, efficient, and proven process has effectively incentivized providers to charge reasonable rates and insurers to pay appropriate amounts in several states. In New York, this arbitration model has curbed the number of surprise bills without raising costs.

With the introduction of this proposal, ACEP is optimistic a solution is in sight that will allow Congress to protect patients from surprise bills while avoiding unintended cost consequences or massive disruption of our health system. We look forward to working with bipartisan members of the House and Senate on measures that hold patients harmless, provide a level playing field for providers in network or in billing negotiations with insurers, and continue to enable emergency physicians to treat anyone, anytime, anywhere, regardless of their insurance status or ability to pay."


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Insurance Reform, Lamar Alexander, Medical Bills, Out-of-Network, Surprise Billing, Surprise Medical Bills
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