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Healthcare groups urge Congress to protect patients from surprise billing

The AHA and FAH said they believe a policy solution to resolve such surprise bills should prohibit balance billing and limit patients' cost-sharing.

Jeff Lagasse, Associate Editor

The American Hospital Association and the Federation of American Hospitals have sent a letter to Congress urging lawmakers to protect patients against surprise medical bills, which can result from unforeseen gaps in insurance coverage.

The groups said they believe a policy solution to resolve such surprise bills should prohibit balance billing and limit patients' cost-sharing to an in-network amount.

IMPACT

"The AHA and the FAH are working together and with our respective memberships to develop specific solutions to these challenges," the letter read in part.

Among those challenges are how to protect the broadest range of patients, including those in self-insured plans. The groups would also like to determine how cost-sharing should be determined for out-of-network care so patients are certain of their financial obligations.

The groups also want to address the role of network advocacy requirements and enforcement in ensuring patients have adequate access to in-network care.

Once patients are protected, the organizations will make a judgement call on whether policy interventions are needed to determine fair provider payment.

"We appreciate that this is a high priority issue for Congress, as it is for us, and we intend to provide more specific feedback to policymakers early in the new Congress," the letter read.

THE TREND

Two 2017 studies show surprise bills can undermine competition between health insurance plans and particularly harm plans that are trying to limit costs by offering narrower network products.

Contracted, in-network providers agree to accept discounted reimbursement rates negotiated with health plans, and health plans typically charge patients lower cost-sharing liability for contracted services.

But 20 percent of emergency department visits and resulting admissions at in-network facilities involved an out-of-network physician.

In December, nine healthcare organizations including America's Health Insurance Plans joined to support federal legislation to end surprise medical bills.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com

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