The Hill reports that Democrats and Republican members of Congress are coming together over legislation that would protect some people from unexpected medical bills. Too often, Americans are going to the emergency room and finding themselves with thousands of dollars of medical bills they thought their insurance would cover. The proposed legislation would be beneficial, but only address the tip of the commercial health insurance iceberg.
Here’s the heart of the problem:
- Congress does not regulate health care prices.
- Congress allows commercial insurers to restrict their coverage to a limited group of medical and hospital providers.
- And, Congress does nothing to protect, or require insurers to protect, people with insurance who are seen unknowingly or in emergency situations by providers who are not in their insurers’ networks.
In our current commercial health insurance system, insured individuals can and do get billed tens of thousands of dollars if they end up receiving out-of-network care even in emergency situations. One insured teacher in Texas received a bill for $108,951 after a heart attack. And, the problem goes beyond emergency situations to situations in which individuals receive in-network hospital care but receive out-of-network doctor care, which is outside their control.
It is not at all clear how often people enrolled in Medicare Advantage plans are faced with surprise medical bills. If you are enrolled in a Medicare Advantage plan, you should be protected against balance billing by out-of-network providers.
For people not enrolled in Medicare, in the US House, Congressmen Frank Pallone(D-NJ) and Greg Walden (R-OR) propose turning responsibility for handling unexpected medical bills to providers and insurers, taking patients out of the middle in emergency situations. This would be a big step forward for patients. But, insurers and providers may try to derail the bill if insurers feel they would be expected to pay more than they think appropriate or providers feel they would be expected to accept lower rates than they think appropriate.
In the Senate, Senators Bill Cassidy (R-La.), Maggie Hassan (D-NH) and Michael Bennet (D-CO) are working on legislation as well. A Senate bill was in play last October. With Congress, even small important bi-partisan fixes can take way too long.
Here’s more from Just Care:
- Congress should level the playing field between traditional Medicare and Medicare Advantage
- Could you pay more in Medicare Advantage than traditional Medicare?
- Medicare ratings of Medicare Advantage plans a farce
- People with serious health needs may not be able to disenroll from Medicare Advantage plans
- Two tips for keeping your emergency care costs down