Will Congress act? And if not, will President Trump?
I’m talking about “surprise” medical bills, those unexpected bills that sometimes show up in our mailboxes after we’ve received treatment – typically without realizing it – from an out-of-network physician.
Surprise medical bills have been a problem for years. Whether we’re any closer at the moment to resolving the problem is a big question mark. President Trump in late September called on Congress to act, declaring that “the days of ripping off American patients are over.”
That, again, remains to be seen, though the White House said it would act by the end of the year if Congress failed to respond. At one point, the administration considered a plan that would have removed providers that issue surprise bills from Medicare and Medicaid programs.
The welcome news is that there’s proposed legislation – the STOP Surprise Medical Billing Act – that has bipartisan support.
Among other things, the bill would set reimbursement rates for out-of-network providers based on in-network reimbursement rates set by the insurer.
The legislation also would mandate the use of independent mediators to help resolve billing disputes and, perhaps best of all, remove patients from the process.
With the upcoming election and Capitol Hill acrimony the norm rather than the exception, it’s impossible to know what Congress will do. But if lawmakers fail to act, the Trump White House says it will take administrative action to prohibit providers from sending bills for expenses that a patient could not have reasonably predicted.
We should all hope something good comes out of this, because even the savviest healthcare consumer can easily find themselves dealing with an unexpected medical bill.
Consider that about one in five commercially insured patients treated at an in-network emergency room is seen by an out-of-network physician. In about one in 10 elective procedures at an in-network hospital with an in-network surgeon, the anesthesiologist, assistant surgeon or similar physician is out-of-network.
A study published in the American Journal of Managed Care found that ending surprise billing would have a big – and positive – impact on everyone’s insurance premiums.
Paying providers 150 percent of Medicare reimbursement levels on surprise billing services could save members enrolled in the nation’s three largest commercial health care plans about $38 billion a year, the researchers found.
In other words, fixing surprise billing won’t just help the patients being billed; it offers the potential to lower health insurance premiums for everyone.
One last, important note on this: Employers of all sizes are increasingly moving to a self-insured scenario that includes a third-party administrator in their corner. These TPAs act as their advocate in all billing disputes, helping reduce fraud, waste and, more to the point, resolving those surprise bills.
Andrew Gibbs is an insurance advisor in CCIG’s Employee Benefits department. Reach him at Andrew.Gibbs@thinkccig.com or at 720-212-2025.
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