“Surprise Bill” Solution is on Senate’s To-Do List

March 20, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Private Insurers

A bipartisan group of U.S. senators is at work on federal “surprise bill” legislation that may be officially proposed within weeks. The proposal will target the common scenario in which an insured individual receives covered healthcare services from an in-network hospital, surgery center, imaging center or laboratory, while an out-of-network healthcare provider also provides non-emergency services to the patient at the facility.  Often, the patient then receives a “surprisingly large” bill from the out-of-network provider.

A number of states, including New York, New Jersey, Connecticut, Florida and California, have already restricted the practice. Although the provisions of state laws vary, they typically require disclosure that a provider is out-of-network, and often limit a patient’s financial obligation to the out-of-network provider to the amount that would have been owed had the provider been in-network unless the patient expressly selected the out-of-network provider to provide services. In non-emergency situations, patients generally can also request an estimate of fees and a detailed breakdown of the services anticipated to be provided.

In a March 18 letter, 17 health insurers and other organizations, including the BlueCross BlueShield Association, National Association of Health Underwriters, and America’s Health Insurance Plans, urged Congress to pass “surprise bill” legislation and take other action to “reign in out-of-control health care costs.”

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