WASHINGTON—U.S. Senators Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO), members of the bipartisan Senate health care price transparency working group, today released draft legislation to protect patients from surprise medical bills. The draft bill is intended to jumpstart discussions in Congress about how to best stop the use of balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.
Recent 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.
“Patients should have the power, even in emergency situations when they are unable to negotiate,” said Dr. Cassidy. “Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame.”
“Increasing transparency is one of the most important steps we must take to improve our health care system,” said Senator Bennet. “Patients deserve to know how much they are paying for health care services and procedures at the point of care. I’ll keep working with my colleagues to find bipartisan solutions like this to lower costs and improve patient care.”
“No one should receive surprise medical bills. This draft legislation will add transparency and fairness to health care costs. I look forward to this important consumer protection becoming law,” said Senator Grassley
“No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency. The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider. I’m proud to work with my colleagues on both sides of the aisle to ensure patients will have more transparency when it comes to the costs of their services or procedures,” said Senator Carper.
“Over the last several months, we have evaluated input from health care experts and stakeholders to determine what steps can be taken to lower health care costs for patients. This evaluation revealed that surprise medical billing is an issue we can address right away to have an immediate impact on health care costs. Surprise medical billing occurs when a patient receives an unexpected medical bill from a doctor that is unknowingly out-of-network. This is just the first of several issues that the bipartisan working group will tackle as a result of our review, and I believe it is the right place to start,” said Senator Young.
“When Missouri families are facing a medical emergency, the last thing they should be worrying about is if the emergency room is in network or if they’ll get stuck with a massive bill after the fact,” said Senator McCaskill. “I’m committed to finding real solutions to help lower the costs of healthcare facing Missourians, and this bipartisan proposal is an important first step towards tackling a tough and costly issue.”
The discussion draft of the Protecting Patients from Surprise Medical Bills Act addresses three scenarios:
- Emergency services provided by an out-of-network provider in an out-of-network facility: The draft bill would ensure that a patient is only required to pay the cost-sharing amount required by their health plan, and a provider may not bill the patient for an additional payment. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.
- Non-Emergency services following an emergency service from an out-of-network facility: The draft bill would ensure that if a patient receives an emergency service from an out-of-network health care provider or facility and requires additional services after being stabilized, the health care facility or hospital will notify the patient, or their designee, that they may be required to pay higher cost-sharing than if they received an in-network service and give the patient an option to transfer to an in-network facility. The patient, or their designee, would also be required to sign a written acknowledgment of that notification.
- Non-Emergency services performed by an out-of-network provider at an in-network facility: The draft bill would ensure that a health plan or out-of-network provider cannot bill a patient beyond their in-network cost-sharing in the case of a non-emergency service that is provided by an out-of-network provider in an in-network facility. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.
This discussion draft would also instruct the secretary of Health and Human Services to conduct a study and issue a public report that includes recommendations to Congress regarding the impact the bill would have on the prevalence of patient cost-sharing, patients’ access to care and the quality of that care, the price of insurance premiums, any change in overall health care costs, the use of emergency rooms, access to new and improved drugs and technology, the adequacy of insurance networks.