President Trump Urges Congress to End “Surprise Medical Billing,” Bipartisan Legislation Expected but Ramifications for Stakeholders Unclear

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During a May 9, 2019 press event, President Trump urged Congress to pass legislation that would protect patients from surprise medical bills.  “Surprise medical billing” occurs when a patient seeks care at an in-network facility but receives treatment or services from a provider that is out of network.  As a result, the patient is billed for the costs associated with the out-of-network services.  A bipartisan group of Senators expects to unveil their legislative approach soon, with the goal of sending a bill to the President in July 2019 to create patient protections against surprise medical billing.  It remains to be seen, however, which stakeholders—hospitals, providers, or insurers—will shoulder the greatest financial burden as costs are shifted away from patients. 

Surprise medical billing is often the result of insurers using narrow networks of providers.  While narrow networks are generally associated with lower health insurance premiums, the services of specialty providers or consultants may not be covered under the network.  For example, a patient who is treated for an arm fracture at an in-network hospital may have the X-ray image interpreted by an out-of-network radiologist.  In that scenario, the patient is responsible for the out-of-network costs associated with the imaging interpretation.

During the press event, President Trump outlined the following five principles to guide Congress in developing bipartisan legislation to end surprise medical billing.

  • Balance billing should be prohibited for emergency care.
  • For non-emergency care, patients should be given prices for all services and out-of-pocket payments for which they will be responsible prior to their treatment.
  • Patients should not be responsible for surprise bills from out-of-network providers that they did not choose themselves.
  • The legislation should not increase federal healthcare expenditures.
  • The legislation should include all types of insurance.

Senators plan to introduce a bill “soon” and send legislation to the President in July to limit surprise medical bills.  Senators leading the effort include Bill Cassidy (R-LA), Maggie Hassan (D-NH), and Lamar Alexander (R-TN).  Previous drafts of similar legislation varied in terms of prescribed solutions; some favored arbitration while others proposed regulating out-of-network charges.  House Energy and Commerce Chairman Frank Pallone (D-NJ) and ranking Republican Greg Walden (R-OR) issued a joint statement noting their commitment to addressing surprise billing and announcing “we have been working together on a bipartisan solution to protect patients that we hope to announce soon.”  With insurers, providers, and hospitals each having distinct interests as stakeholders in surprise medical billing reform, it is unknown which stakeholders Congress will select to absorb the costs that are shifted away from patients.  

President Trump’s remarks are available here

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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