Today we’ll consider the No Surprises Act, which I introduced with Ranking Member Walden to address the issue of surprise medical billing. Our legislation removes the ‘surprise’ from billing by completely protecting patients in emergency situations, patients who did not specifically choose to see an out-of-network physician for scheduled care, and patients in situations where there is no in-network provider available to treat them. This legislation protects consumers and it does it without raising healthcare costs for working Americans. It’s critical that we pass this legislation today and finally protect patients from these outrageous surprise medical bills.
Unintended Costs of Care
A patient is rushed to the emergency room, diagnosed, and taken to surgery immediately. The patient recovers, but weeks later a bill arrives beyond any expectation, and too often ability, to be paid. This practice has become so routine that it has its own name: balance billing or, more commonly, surprise medical billing. It strikes many Americans with the burden of their ailment once again.
As health care continues to top domestic policy issues, bipartisan attempts to tackle its aspects are delving deeper into how consumers are charged for medical treatment and how to fix it.
Balance billing is an accepted term defined as “when a provider bills a patient for the difference between the provider’s charge and the allowed amount.” Under the law, which varies by state, out-of-network providers may bill patients for the difference between the cost of a procedure and the amount the deductible, copay, and insurance have agreed on as a set price. Many times the difference is astronomical, and patients are unaware of their potential financial liability for the amount—hence the new vernacular, “surprise medical billing.”
Congressional Oversight Seeks Clarification
Most balance billings are for prearranged treatment with providers who are outside of patients’ health insurance networks. Many are for cosmetic procedures in which patients are aware of their responsibility for any fees above the amount specified by their insurance coverage. Balance billing is illegal for Medicare and Medicaid providers because their government contracts have set scales for reimbursements and any billing beyond that violates the law.
U.S. Congressional representatives held hearings with consumers, advocacy groups, providers, and healthcare institutions to better understand the adverse impact that surprise billing has on patients. In response, the U.S. House of Representatives submitted the No Surprises Act (H.R. 3630) that says:
“Any cost-sharing payments made by the participant, beneficiary, or enrollee with respect to such emergency services so furnished shall be counted toward any in-network deductible or out-of-pocket maximums applied under the plan in the same manner as if such cost-sharing payments were with respect to emergency services furnished by a participating provider and a participating emergency facility.”
And the U.S. Senate submitted the Lower Health Care Costs Act (S. 1895), which includes the sections “protecting patients against out-of-network deductibles in emergencies,” “protecting against surprise bills,” “in-network guarantee,” and “coverage of out-of-network emergency services.” Although neither bill has been passed out of its committee, the fact that both chambers have moved so quickly on a single issue and wrapped it into their respective institution’s agenda is a bold statement of support.
Other healthcare bills intended to promote transparent and more accessable, affordable care were introduced in July 2019. The bills will likely be rolled together and streamlined into a single, larger bill to encompass as many of the top health issues as possible, including holding patients harmless for surprise insurance gaps, tying out-of-pocket payment rates to average in-network rates, and offering the ability to settle bills through arbitration.
Still Some Resistance to Change
Some physicians in Congress and professional medical organizations have lobbied against change, saying that the legislation’s unintended consequences would increase the physician shortage, making it more challenging for patients to see preferred providers. Additionally, more progressive Congressional members did not support the legislation because they said it put a cap on the time for disputes to be completed.
Most agreed that no bill will be passed out of both houses before fall 2019, but political insiders reported that the issue resonates with both parties and President Trump as a commitment to campaign promises to find real solutions to America’s high healthcare costs.
On July 17, 2019, the House Energy and Commerce Committee approved its legislation with a caveat allowing for some fee disputes to be resolved by arbitration. “We’ve done our best to hear all sides of the issue, and I think we’ve landed with a strong product that will provide consumers with significant protections from surprise medical bills,” Pallone said, who supported the amendment along with ranking member Representative Greg Walden (R-OR).
Advocacy Continues With Nurses as Educators
A key provision in the American Nurses Association’s public policy agenda is to “ensure universal access to a standard package of essential health care services for all citizens and residents.” ONS is a leader in nurse advocacy and educating decision makers about patient-centered care and nurses’ role in issues affecting access and affordability. Join the chorus of oncology nurses fighting for their patients to have that right. For more information, visit ONS.org.