A comprehensive permanent fix to end surprise medical billing will be most effectively achieved through legislation, according to senior officials with the Department of Health and Human Services.
A new report by HHS Secretary Alex Azar is calling for congressional action to combat surprise billing and to promote price transparency.
The report, "Improving Price and Quality Transparency in American Healthcare to Put Patients First," outlines steps, including congressional action, to implement principles on surprise billing that were called for in President Trump's Executive Order in 2019.
These include the principles that patients receiving emergency care should not be forced to shoulder extra costs billed by a care provider that are not covered by their insurer; that patients receiving scheduled care should have information about whether providers are in or out of their network and what costs they may face; patients should not receive surprise bills from out-of-network providers they did not choose; and that federal healthcare expenditures should not increase.
Surprise billing occurs when a patient sees an out-of-network provider during an emergency, or in a nonemergency case in which a patient sees an in-network provider but gets care from an out-of-network provider, such as an anesthesiologist.
When a patient receives out-of-network care, many times unknowingly, they may receive the balance of the bill, or the difference between full charges and what's been paid.
Out-of-network care mostly occurs due to care given by ancillary providers, HHS said. Federal legislation is the appropriate remedy.
WHY THIS MATTERS
Surprise medical billing, already a costly problem, has been highlighted during the Public Health Emergency presented by COVID-19.
Practices such as surprise billing leave many patients vulnerable to the financial burdens presented by a nationwide pandemic.
Research shows that 41% of insured adults nationwide were surprised by a medical bill in the past two years and that two thirds of adults worry about their ability to afford an unexpected medical bill.
THE LARGER TREND
HHS already has two regulations in place to address price transparency.
One, poised to go into effect January 1, 2021, requires hospitals to establish, update, and make public, at least annually, a list of their standard charges for the items and services that they provide.
The second companion proposed rule would demand similar transparency from most group health plans and issuers of health insurance coverage within both the individual and group markets.
In June, the American Hospital Association said it would appeal a decision handed up in federal court requiring hospitals to disclose their privately negotiated rates with commercial health insurers.
ON THE RECORD
"Americans have the right to know what a healthcare service is going to cost before they receive it," said HHS Secretary Alex Azar. "President Trump and his administration have done their part to deliver historic transparency around the prices of many procedures. Now it's time for Congress to do what we all agree is necessary: combat surprise billing with an approach that puts patients in control and benefits all Americans."
Email the writer: firstname.lastname@example.org