WASHINGTON–U.S. Senator Bill Cassidy, M.D. (R-LA), during today’s Senate Health Education Labor and Pensions Committee hearing on lowering health care costs, shared his personal experiences receiving a surprise medical bill. He also explained how his legislation, the STOP Surprise Medical Bills Act (S. 1531) would prevent other Americans from having the same experience in the future. Currently, 24 Senators are cosponsoring Cassidy’s legislation, nearly one quarter of the Senate.
Under Cassidy’s legislation, out-of-network providers would automatically be paid a benchmark of the difference between the patient’s in-network cost-sharing amount and the median in-network rate for services, but providers and insurers would have the opportunity to appeal this payment amount through an independent dispute resolution process, should they see fit.
A partial transcript of Cassidy’s remarks are transcribed below:
Cassidy: Doctor [sic] Ippolito, um, two stories. My daughter got kicked off of Alice in Wonderland in Central Park and we took her to the emergency room and she’s bleeding from her forehead and the ER said we don’t have a plastic guy. Go to his office. So we went to his office, I got a bill for $3,000 for glue the guy put in—it took him five seconds to place.
I was at a tennis match here in DC and all of a sudden I get this black spot. I call ophthalmologist friend of mine and he goes you’re having a retinal tear go to the ER right away. I go to the ER. They say you don’t need an ER. We’re gonna hook you up with the ophthalmologist and go see him tomorrow morning. Both emergencies, now, in that case I think I got a bill for $1,500, both out-of-network. Does network matching helped me in either of those situations in which I was not seen in a hospital but rather referred to the physician’s office?
Benedic N. Ippolito: Yeah so that’s a very good question. It’s very good clarifying question. The in-network guarantee would take care of a very large portion of the surprise bills, but they are the ones that occur at your in-network facility.
Cassidy: So on the other hand what doctor—I’m sorry—Miss Hassan was speaking of, I do gather that under the proposal that she and I have, I would have been cared for in both situations in which there would have been an in-network price and so there would’ve been an out-of-network dispute, but I wouldn’t have paid $3,000 for 20 seconds worth of glue or $1,500, probably worth it because I got my retina back in place, but nonetheless it was out-of-network. So I want to say there is a superiority and I think we’re naïve if we don’t think that there would be more migration out of the in-network hospital into a setting not covered by an in-network-rate if we were to put restrictions upon that which a physician could bill. I mean we would just be naive to otherwise think so.
Ippolito: I would clarify one point. The first is that both an arbitration and a benchmark system would have covered you in that in
that case that you’re talking about.
Cassidy: Arbitration and benchmarking would, but not an in-network?
Ippolito: That’s exactly right…