Have you ever received a surprising, shockingly large medical bill from a hospital or doctor group you could have sworn your insurance covered? You’re not alone. This is called “balance billing,” and three-quarters of all Americans want the federal government to protect unwitting patients from it.
What is balance billing?
Large, surprising medical bills (balance billing) 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 treatment is not.
More often than not, most patients who receive 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 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 exorbitant) bill. If the patient is not an expert negotiator, this too often results in financial devastation.
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According to a poll from the Kaiser Family Foundation, this happened to approximately 40 percent of Americans within the last two years–Americans who felt confident their insurance would cover the treatment they were receiving.
The poll also found that approximately 90 percent of Democrats and 60 percent of Republicans support Congress passing a federal law to protect patients from balance billing.
Around two dozen states have some sort of protection in place to protect patients from balance billing. However, these laws do not protect patients outside of these states, and they do not extend to people who receive insurance through their employer. This means about 60 percent of Americans are not protected from balance billing.
This is a major problem for many Americans. A patient may be able to “shop around” for a general practitioner covered by their insurance, but they rarely have that option when it comes to a provider such as an anesthesiologist. The problem is even worse for patients in rural areas whose healthcare needs are already limited.
Several bills have been proposed to protect Americans from this exploitative practice:
- Senator Bill Cassidy (R-LA) proposed a bill that would cap what patients pay and prohibit balance billing.
- Senator Maggie Hassan (D-NH) presented a bill which would prevent hospitals and doctors from charging more for emergency out-of-network services than they would for in-network care.
- Representative Lloyd Doggett (D-TX) introduced a bill that would require hospitals to notify whether they and the doctor providing care are within the patient’s network, and if not, what the projected cost would be for treatment.
Responses from politicians
Last month, the House Health, Employment, Labor and Pension subcommittee of the Education & Labor Committee heard testimony from witnesses whose lives have been impacted by balance billing.
Representative Susan Wild (D-PA) acknowledged that balance billing is something both Democrats and Republicans can agree is a problem that should be addressed immediately, but she does not see a solution on the horizon. “The solutions I’m hearing don’t sound workable in the context of our present medical system,” she said. “Isn’t the real problem the fact that we’ve turned over our medical system to private market forces?”
Representative Tim Walberg, a ranking Republican on the committee, said, “We have people on this committee that have done yeoman efforts to come up with solutions in their own states. I think we have a head start in understanding some of the pitfalls to stay away from and some of the benefits we can go directly toward.”
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