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Bi-partisan bill in Congress would prevent surprise medical bills

Written by Diane Archer

Millions of insured Americans go to the hospital, thinking that their bills will be covered only to be surprised by unexpected medical bills. Too often, they end up in medical bankruptcy. Out-of-network doctors and other health care providers may charge people tens of thousands of dollars. Finally, there’s a bipartisan bill in Congress that would prevent surprise medical bills.

Senator Cassidy (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO) have introduced S._____  The bill would forbid out-of-network care providers from billing patients for their services over which the patients have no control. These bills usually are a result of patients needing emergency hospital care and having no ability to ensure  the hospital they are taken to or the providers who treat them are in-network.

The bill would protect patients from having to pay out of pocket for out-of-network care any more than they would pay for in-network care. Their health insurance would pay any additional charges up to a designated limit.  This bill would make a major difference for thousands of patients. Kaiser Health News has reported that people have received surprise bills for a $17,850 urine test and for $109,000 after a heart attack.

The Senate bill would also protect emergency room patients in an out-of-network hospital once they are stabilized. At that point, the hospital would have to notify them in writing that they will be billed for its out-of-network services. The patients could sign a waiver agreeing to pay privately for that care. Or, they would have the right to move to an in-network hospital.

More than half of all workers with health insurance through their employers (61 percent) are in self-funded plans. The employers pay claims directly rather than through insurance. And, out-of-network hospitals and doctors today can charge these plans what they will. This bill would no longer allow this type of balance billing.

For now, here’s how to protect yourself from surprise medical bills.

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