Tom's Take Blog

July 11, 2019

What’s being done to regulate surprise billing in health care?

Tom’s Take: Surprise billing has been a hot topic in the news lately as the current administration is looking to pass legislation in 2019 that will put an end to this widespread, high-cost problem in the health care industry.

 

How common is it? According to a report published in Modern Healthcare, 1 in 7 patients receives a surprise medical bill even when an in-network hospital has been selected. These charges – originating when care doesn’t fall within a patient’s insurance plan network and gets balance billed – can cost up to tens of thousands of dollars and cause patients a lot of extra headaches in trying to resolve the discrepancies and lower the amounts invoiced. There are a lot of triggers for surprise billing … some of the more common ones include anesthesiology, radiology/labs and emergency care costs.

 

Many states have stepped in to try and deal with this long-time problem by introducing different patient protections. Even with these measures in place, surprise bills are still happening, and it’s become clear that further legislation needs to be implemented at the federal level.

 

What we’re seeing now is a lot of bi-partisan attention on the issue, with proposed bills being drafted by members of the Senate and House of Representatives. Hearings have taken place and there have been talks of everything from capping out-of-network charges to bundling services and using arbitration to resolve disputes. So far, no final resolution has been reached as health insurers and providers haven’t been able to get on the same page and agree on the best approach.

 

As we wait for a solution, the good news is this: the pressure is definitely on from the administration to get something done and address surprise billing. Until that happens, patients need to be smart consumers, and TPAs should continue to work with the health plans they administer to implement helpful solutions. That means doing some homework when a procedure is pre-planned to check if providers/hospitals are in-network and working through costs in advance (to avoid those costly surprises!) with things like medical tourism and concierge services. It also means being diligent about reviewing all health claims/billing statements for accuracy after care is received and following up on any questionable charges.

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