Stopping Surprise Medical Bills: Federal Action Is Needed

Surprise medical bills occur when patients cannot avoid being treated by providers outside their health plan’s contracted network — either because the provider is not chosen by the patient, for example the emergency department physician or the anesthesiologist assisting a surgery, or because patients are not even aware that the provider is involved in their care, such as a pathologist examining a biopsy. Contracted, in-network providers have agreed to accept discounted reimbursement rates negotiated with health plans, and health plans typically charge patients lower cost sharing liability for contracted services. In contrast, patients face a triple-whammy when being treated by non-contracted providers: out-of-network providers can bill patients at higher—and sometimes much higher—rates; health plans typically pay a smaller share of the charges they allow; and patients remain liable for the difference between plan allowable amounts and the amount being billed. When this happens, and there is increasing evidence that it happens often across all types of plans, patients can suffer from substantial financial harm and distress. Even when patients are diligent in seeking an in-network hospital or lead physician, their care often involves consulting specialists—such as radiologists, anesthesiologists, pathologists, neonatologists, or assistant surgeons—who are out-of-network and whom the patient has no role in selecting. Legally, patients might be abl...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Health Professionals Hospitals Payment Policy balance billing Emergency Medicine surprise billing Source Type: blogs