Just as Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) formally introduced a wide-ranging bill last week that seeks to address "surprise bills," a new report was published finding that in 2017 1 in 6 Americans were surprised by a medical bill after treatment in a hospital despite having insurance.
On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge, according to California Healthline. Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation.
To combat this, the Senate health committee has agreed on a policy to ban surprise medical bills using a cap on the pay physicians, hospitals and air ambulances can collect for out-of-network care.
When a patient is seen by a doctor who isn’t in their network, the Alexander-Murray bill says insurance would pay them the “median in-network rate,” meaning the rate would be similar to what the plan pays other doctors in the area for the same procedure, according to Kaiser Health News. If there aren’t enough other doctors covered by the plan to compute a median in-network, the plan would use a database of local charges that is “free of conflicts of interest.”
“New York and California have very high rates of surprise bills even though they have some of the strongest state statutes,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation and an author of the study. “These data show why federal legislation would matter.”
The Alexander-Murray legislation says that any care the patient receives would count toward their in-network cost sharing, like their deductible, coinsurance or copay.
In addition, on the provision that mandates hospitals and doctors to bill their patients promptly, providers would have up to 45 days, up from the 30 days required in the discussion draft, to send a bill. If a bill arrives 45 days after their treatment, they would not need to pay that bill.
The committee is expected to vote on the legislation before July.