WASHINGTON (CN) – Republicans and Democrats may not be able to agree on much these days but a bipartisan push to stop surprise medical billing is coursing through Congress as health care industry leaders met with lawmakers Tuesday to urge support of legislation that removes the financial guesswork for patients.
Congresswoman Katie Porter, a California Democrat, is familiar with surprise medical billing, just like hundreds of thousands of other Americans who show up at the emergency room, leave and then receive a bill in the mail for services they may have assumed were covered by their insurers.
During her campaign for California’s 45th Congressional District, Porter’s appendix burst and she knew before was ferried away to an emergency room that an unexpected charge may be part of the already harrowing experience.
To avoid any surprises, she asked her campaign manager to determine whether the nearest hospital was in her insurance network.
It was not, so Porter chose another hospital that was in her network, even though it was further away. One appendectomy and five days in the hospital later, Porter thought she was in the clear only to receive a bill from a surgeon for roughly $3,000.
The surgeon, even though he worked in the hospital Porter chose because it was in network, was himself not in the network and the lawmaker was stuck with the bill.
“There are thousands of Americans with fewer resources than me who are surprised with bills far more devastating than mine,” Porter said during Tuesday’s hearing in the House Ways and Means Health subcommittee, adding that families can go bankrupt because of surprise bills.
She said a solution is needed, and fast – but equally important is that any federal legislation put forth does not require patients to take the lead on negotiating coverage costs.
Simply put, Porter said, patients should not have to “go to war” with their physician and insurance provider to get a fair deal.
There is currently only a patchwork of state guidelines in place protecting consumers from surprise medical bills, but sweeping federal legislation to stop the practice altogether could prevent an already financially strapped family from going underwater completely, said Jeannette Thornton, senior vice president for the trade association America’s Health Insurance Plans.
According to a Schwab wealth survey released this month, only 38% of Americans polled have access to an emergency fund with more than $1,000. The majority of Americans, roughly 59%, live paycheck to paycheck.
Feeling the pressure of financial instability is an experience common to most Americans, not just those on the right or left side of an issue.
Two weeks ago, the White House announced its wish to see surprise medical billing legislation rolled out and within a week, Republicans and Democrats on the House Energy and Commerce Committee issued draft legislation known as the No Surprises Act to meet that end.
The bill, in its earliest stage of development, has not been heard in a committee yet. Not only would it end surprise billing practices, the legislation would also stipulate that patients must be amply notified about the network status of any doctor who could treat them.
The days of patients running back and forth between an insurer and health care provider to resolve mystery bills would also be a thing of the past, according to a discussion draft of the No Surprises Act.
The bill “establishes a minimum payment standard set at the median contracted (in-network) rate for the service in the geographic area the service was delivered. It also preserves a state’s ability to determine their own payment standards for plans regulated by the state,” the draft states. (Parentheses in original.)
Another piece of legislation is also under review in the Senate. Unlike its companion in the House, the Senate bill, known as the Stopping the Outrageous Practice of Surprise Bills Act of 2019, would allow for an independent dispute resolution process, ultimately giving providers a chance to set a different payment rate than whatever the median in-network rate is.
There are also a variety of stipulations in both bills that would make understanding coverage easier and making records more transparent.
As lawmakers on Capitol Hill will continue to meet and discuss the federal legislation, on Tuesday afternoon the Texas House of Representatives made its position known: state lawmakers voted 146-0 to ban surprise medical bills in the Lone Star State.
The bill, known as SB 1264, is now destined for the Texas Senate for a procedural vote. If approved there and signed by the governor, it would take effect on Jan. 1, 2020.