man looks surprised at balance billing

House Bill Takes Aim at Balance Billing Practices

Earlier this month, the House Ways and Means health subcommittee gathered to address the issue of “balance billing,” or surprise medical bills. The hope is to protect patients on a federal level from exorbitant medical bills they’ve unwittingly accumulated while receiving healthcare.

What is balance billing?

Large, surprising medical bills may pop up in several different situations, like:

  • A patient is taken to the emergency room by an out-of-network ambulance,
  • The ER they are taken to is not in network, or
  • The hospital or doctor group is in network, but the specific doctor providing their treatment is not.

More often than not, most patients hit by balance billing fall into the last category. Many receive treatment from doctors they assume are covered by their insurance, only to find out after treatment and discharge that the individual doctor was not.

In this situation, the insurance company agrees to pay a certain amount, but the out-of-network doctor can essentially charge whatever they want, and the patient is left picking up the (often astonishingly high) bill. If the patient is not an expert negotiator or aware that negotiation is an option, this too often results in financial devastation.

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How would the bill help?

Representative Lloyd Doggett (D-TX) introduced H.R. 861, or the End Surprise Billing Act of 2019, which received 30 cosponsors.

This bill would require Medicare-approved hospitals to provide balance billing notices to their patients before they receive treatment from doctors not covered by their plan. The notice would inform a patient that they are using an out-of-network doctor or hospital, and provide them with a list of anticipated costs.

Under this bill any Medicare-approved hospital that declined to provide balance billing notices would only be allowed to charge in-network prices. The same is true for patients who have received emergency care from an out-of-network hospital. Once discharged, the patient would be billed their usual cost-sharing amount as if the hospital had been in-network.

Doggett said, “The sole focus of the bill is to protect insured patients from being trapped between an insurer and an out-of-network provider.”

Approximately two dozen states, such as California, Minnesota, and Texas, have some level of balance billing protection in place, but Doggett is attempting to pass this protection at the federal level.

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