By Leslie Small
In mid-September, a bipartisan group
of senators led by Sen. Bill Cassidy (R-La.) unveiled draft legislation that
aims to shield consumers from getting hit with unexpected medical bills.
However, experts say there are parts of the draft bill that might need to be
refined to ensure that the solution to surprise billing doesn’t have unintended
consequences.
According to a survey released Aug. 30 by NORC at the University
of Chicago, 57% of American adults say they’ve received a bill for medical
services they thought would have been covered by insurance. Respondents
indicated that 20% of their surprise bills resulted from receiving care from a
doctor not in their insurance network.
During the 2018 legislative session, six states passed new laws
designed to protect consumers from surprise bills, according to the National
Academy for State Health Policy (NASHP). The laws, which vary in design and
comprehensiveness, build on actions taken by those states and others to address
the problem in previous years.
Cassidy’s draft bill would fill the regulatory gap left by that
patchwork of state laws and the fact that the federal government, not states,
regulates self-funded insurance plans offered by large employers.
Here’s how the law would work: If patients receive either
emergency or non-emergency services from an out-of-network provider at an
in-network facility, they cannot be billed any more than the amount of their
in-network cost-sharing. Instead, a patient’s health plan would be responsible
for shouldering the remaining balance, paying whichever is greater: the median
in-network contracted rate for the service in a specified geographic area, or
125% of the average amount for the service allowed by all health plans in a
specified geographic area.
Further, for patients who receive emergency services from an
out-of-network provider and then require additional services after being
stabilized, the facility must alert such patients that they could face a high
cost-sharing amount and give them the option of transferring to an in-network
facility.
From Health Plan Weekly
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