Congress agreed to ban surprise medical bills in their funding package passed this week, the culmination of two years of work from Senator Maggie Hassan and a Republican senator from Louisiana.
Until now, patients could be charged with thousands of dollars in medical bills for unintentionally receiving care from out-of-network physicians.
This often occurs when patients go to in-network hospitals that have quietly hired out-of-network specialists.
Insurance companies have no contract with the out-of-network providers and are therefore not obligated to cover the cost of their bill. Ultimately, the bill is passed onto the patient.
“Patients who follow all the rules to try to ensure that their care is covered in-network are still hit with massive, unexpected bills,” Hassan said.
A 2017 study found that this practice is remarkably common— one in five emergency room visits resulted in a surprise medical bill. Another survey found seven in 10 patients who have received unaffordable out-of-network medical bills were unaware that their provider was out-of-network.
The average surprise bill is $600. In 2018, New Hampshire enacted a bill that requires insurance companies in N.H to prohibit this type of billing in their contracts with local health care providers.
However, state laws have no jurisdiction over health plans that are “self-funded.”
That means the law doesn’t apply to the majority of Granite Staters who received health coverage through work.
Nationally, about 60% of workers are covered by a “self-funded” health plan.
Furthermore, the new federal law would prevent surprise billing from air ambulances, a faction of the healthcare industry New Hampshire can’t regulate, which can cost tens of thousands of dollars.
Under the proposed federal law, providers and insurance companies will have to negotiate a payment amount among themselves, instead of charging patients.
The law would also create a process to resolve any payment disputes between health care providers and insurers.
For amounts less than $750, median in-network rates of similar services in the same geographic area are used to determine a fair price.
For amounts above $750, providers and payers may use an independent dispute resolution to determine a fair payment amount.
Patients are shielded from out-of-network prices if they receive non-emergency care from an in-network facility, emergency care from any facility, or if they take an air ambulance.
The prospect of ending surprise medical billing has been widely popular with Americans.
A poll earlier this month found that nearly half of Americans said they wouldn’t be able to pay a $1,000 surprise medical bill and 81% of Americans supported legislation to end surprise billing.
Patients aren’t entirely protected from blindsiding bills, though. The law exempts ambulances, the source of many unexpected charges.
Most ambulance rides, according to the 2017 study, result in surprise bills.
“For far too long, our constituents have done everything right at the doctor’s office or hospital, yet still found themselves stuck with surprise medical bills, sometimes to the tune of tens of thousands of dollars,” Hassan and Senb. Bill Cassidy said in a joint statement. “And frequently, they have to fight these bills at the same time they are facing a medical crisis.”