Lawmakers Bid to End Surprise Medical Billing

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A group of bipartisan lawmakers is hoping to put an end to surprise medical billing—the practice of charging unsuspecting patients with large bills from out-of-network providers. 

The No Surprises Act would, in essence, require health insurance plans to treat certain out-of-network bills as if they were in-network. Patients would only be charged the in-network cost-sharing amount for out-of-network emergency care or when certain services were provided by out-of-network providers but done at in-network facilities, perhaps without the patient realizing it. 

A letter from 27 Republican and Democratic senators urges Senate leaders to include the bill in the year-end spending legislation that’s pending, and the Wall Street Journal reported it likely would be, citing aides.

“The practice of surprise medical billing needs to end,” the senators said in the letter this week. “This practice has been especially damaging during COVID-19 when patients receive large unexpected bills weeks after they go to the emergency room. There will never be a broader bipartisan, bicameral solution to ending surprise medical billing and we should deal with it now. Patients cannot wait any longer.” 

Research shows people often receive care from an out-of-network provider without realizing it, either because they’re getting treated for an emergency or because of a lack of transparency about out-of-network services, like anesthesiology or radiology, being offered through an in-network provider. Americans fear surprise medical bills so much that nearly half of adults in an October survey said they were reluctant to seek medical care.

One study by researchers at the University of Southern California showed surprise medical bills at ambulatory surgery centers averaged $1,483 in 2017. Twenty percent of hospital admissions originating in emergency rooms in 2014 were likely to lead to a surprise medical bill, according to a separate study by researchers at the Federal Trade Commission.

The new bill would also stop surprise bills for air ambulances, requiring that patients only pay the in-network cost-sharing amount when these ambulance rides are out-of-network. One study of members of a large national insurance plan showed 71% of air ambulance rides involved potential surprise bills between 2013 and 2017, and the median bill was $21,698, researchers at the University of Michigan found.