Congress examines surprise billing

by Julia Kyles, CPC on Apr 3, 2019

Surprise medical billing sounds bad; the reality is worse: A patient receives a large and unexpected medical bill because he received health care from a provider who was not in the patient’s health insurance network.

It’s not surprising that surprise billing is unpopular. However, only a few states have laws that provide comprehensive protection from surprise billing. Now members of Congress are mulling a national solution to the issue. Three senators introduced bills that would bar the practice for emergency care last year.

And the subcommittee on Health, Employment, Labor, and Pensions of the Education and Labor Committee held Congress’ first hearing on surprise medical billing yesterday. “We are here this morning to examine surprise medical billing–a serious issue that can disrupt, if not devastate, the lives of individuals and families,” stated chairwoman Rep. Frederica Wilson (D-Fla.) in the prepared portion of her opening statement.

Committee member Rep. Phil Roe, M.D. (R-Tenn.) complained that he had been “negotiated out of networks” and warned that he had been falsely listed as in-network. “Many of those unscrupulous networks will use that to get people to sign up, because 'my doctor is in there' when they're really not, and you get a surprise bill.”

Industry giants weighed in as well. AHIP, FHA, AHA and the AMA all agree that surprise billing is a huge problem and offered their solutions. Industry leaders called for simple solutions – ones that won’t disrupt payments – but the complexity of U.S. health care may keep the status quo in place. As Rep. Susan Wild (D-Pa.) observed:

"I'm struck by the fact that we all seem to be wanting a solution to this problem, but the solutions I'm hearing don't sound really workable in the context of our present medical system, and that's where I struggle to understand how we're going to fix this."

Blog Tags: health care reform
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