President Obama’s Budget Takes State-Level Debates Over Surprise Out-of-Network Bills To National Policymakers

President Obama’s final budget proposal was met with little fanfare, but a lot of political opposition. The President, however, put forth one legislative proposal that deserves attention. It is aimed at helping consumers who get stuck with surprise bills from out-of-network health care providers. Specifically, the proposal would protect patients from having to pay unexpected fees to out-of-network providers for services delivered while they are in an in-network hospital. Although details are sparse, the administration proposes to require hospitals to take “reasonable steps” to match patients with physicians who are in their health plan’s network, and require physicians who “regularly provide” services in hospitals to accept in-network rates. Surprise billing can occur when an individual is unaware that they are receiving treatment from a provider that is not included in his or her health insurance plan (i.e., out of network). This can happen during a medical emergency, but also is not uncommon when patients are admitted to in-network hospitals for planned procedures. Some physicians who provide services to the patient (such as anesthesiologists, pathologists, or emergency room physicians) may not have contracts with the patient’s health plan even in situations when the hospital and admitting physician are in network. Today in most states, these non-network providers are under no obligation to accept the health plan’s reimbursement and can separately bill for t...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Health Professionals Insurance and Coverage Payment Policy 2017 budget in-network hopsitals insurers out-of-network billing Physicians States Source Type: blogs