05.16.19

Sullivan Fights to Protect Patients from Surprise Medical Bills

WASHINGTON, D.C. – U.S. Senator Dan Sullivan (R-AK) yesterday cosponsored the bipartisan STOP Surprise Medical Bills Act, legislation introduced with Senators Lisa Murkowski (R-AK), Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Maggie Hassan (D-NH), and Tom Carper (D-DE) to protect patients from surprise medical bills.

 

“Through no fault of their own, too many Americans get hit with outrageously expensive medical bills as a result of a confusing and opaque health care billing system,” saidSenator Sullivan. “This bipartisan bill protects patients from financial strain as the result of disputes between insurance companies and providers and significantly increases the transparency of that process. This legislation is a major step in the right direction of lowering the exorbitant cost of healthcare and I hope that it will get signed into law without delay.”

 

“Patients should be the reason for the care, not an excuse for the bill,” said Dr. Cassidy. “We have worked for almost a year with patient groups, doctors, insurers and hospitals to refine this proposal. This is a bipartisan solution ensuring patients are protected and don’t receive surprise bills that are uncapped by anything but a sense of shame.”

 

“Many Americans struggle to afford healthcare so the last thing they need is to get hit with unexpected costs added to their already high medical bills. Whether it’s an emergency surgery or an elective procedure, this legislation helps to protect patients from unexpected expenses and ensures greater transparency of costs,” said Senator Murkowski. “This bill is the result of months-long bipartisan efforts in the Senate, and I’m encouraged to know that there is also movement on this initiative in the House and support from the Administration. It’s long past time for an all-hands on deck effort to address the rising costs of healthcare.”

 

“This bipartisan proposal would ensure that no patient will ever again be subject to outrageously high ‘surprise bills’ as the result of a hospital visit,” said John Rother, President and CEO of the National Coalition on Health Care. “Americans should have confidence that they will be treated fairly the next time they visit an emergency room. The National Coalition on Health Care commends Senators Cassidy and Hassan for their leadership on this issue, and we urge swift consideration by the Congress. Health care is expensive enough without families being subjected to price gouging just when they are most vulnerable.

 

“We work every day with patients who have done everything right—have insurance, inquire about network status—but they're still caught in the middle of a system over which they have no control. They still wind up with enormous surprise bills,” said Alan Balch, CEO of the National Patient Advocate Foundation. “We are excited to see lawmakers working together to create a more fair system for patients and their families.”

 

The STOP Surprise Medical Bills Act addresses three scenarios in which surprise medical billing (also known as “balance billing”) would be prohibited:

 

  • Emergency services:  The bill would ensure that a patient receiving emergency care is only liable for the in-network cost of treatment, regardless of the facility or provider network status.
  • Non-Emergency services following an emergency service at an out-of-network facility: Patients who require additional treatment following an emergency at an out-of-network facility would be protected, if they cannot be moved without medical transport from the out-of-network facility.
  • Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.

 

Additional patient-friendly protections:

  • Ensures patient payments for these medical services count toward their in-network deductible and in-network out-of-pocket maximum.
  • Ensures that patients have expected out of pocket cost estimates up-front for scheduled elective services, as well as access to price information for services across different settings of care specific to their insurance plan (i.e. an online price tool). 
  • Requires that ancillary services provided by individual,s such as EKG techs, laboratory techs, and phlebotomists, will be included in the hospital bill and not sent separately; additionally, requires HHS to study the feasibility of hospitals and provider groups providing one bill to patients.
  • Enables patients to have a clear understanding of their insurance plan’s in-network and out-of-network deductibles by clearly listing it on their insurance card.

Examples of patients receiving surprise medical bills include a patient who received a bill of nearly $109,000 for care after a heart attack, and a patient who received a bill for $17,850 for a urine test.

 

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