JustCare

Tag: ERISA

  • When will Congress address surprise ambulance bills?

    When will Congress address surprise ambulance bills?

    Surprise medical bills are all too common, leaving millions of Americans with health care costs they did not expect to pay. A couple of years ago, Congress passed legislation to end surprise medical bills for some services, but the ambulance industry was able to keep Congress from protecting Americans from surprise ambulance bills. Fortunately, people with Medicare have protections and generally do not have to worry.

    Congress was resistant to addressing surprise ambulance bills allegedly in deference to municipalities that generate substantial revenue from running ambulance services. Congress also claimed not to have a good handle on the appropriate cost of ambulance services.

    A new report from US PIRG describes the toll that surprise medical bills takes on Americans needing ambulance services. Even in the 10 states that go farther than federal law to protect their insured residents from surprise ambulance bills, anyone working for a large employer with a self-funded ERISA health plan—a very large cohort—does not have protection from their state laws.

    The problem of surprise ambulance bills needs addressing for multiple reasons. For one, we are talking about a large cohort of the population. Some three million Americans with private insurance use ambulance services each year. Who knows how many do not seek critical care for fear of the cost, endangering themselves.

    Second, when people call 911, they have no control over whether the ambulance that comes for them is in their health care provider network. About half the time the ambulances are out of network. Every ambulance affiliated with 911 should be in the insurers’ networks.

    Today, working Americans with health insurance are scared to call 911 in an emergency, for fear of an ambulance arriving that is out of network and receiving a surprise bill that they cannot afford to pay or do not want to add to their list of expenses. The typical out-of-pocket cost is $450, but in some states it is more than $1,000. Millions of Americans at risk.

    What you can do: Talk to your members of Congress about the urgent need to end surprise ambulance bills. In the meantime, find out which ambulance services are in your health plan’s network, and put their numbers in your phone contact list and/or on a list of important contacts in your home. Share it with your loved ones and  health care proxy.

    Here’s more from Just Care:

  • How to protect yourself from surprise medical bills?

    How to protect yourself from surprise medical bills?

    Watch out for huge medical bills if you visit the emergency room and are enrolled in a commercial health plan. They are common, and Kaiser Health News reports that these bills are often permissible. What should be done to end surprise medical bills? Medicare for All, of course. How can you protect yourself from surprise medical bills?

    In today’s commercial health care system, you want to avoid out-of-network emergency care if at all possible. Plan ahead and identify the emergency room in your health plan’s network and the in-network ambulance that will take you there. If not, here’s one example of what can happen: In the Spring of 2017, St. David’s Medical Center charged a teacher $108,951 for his four-day emergency stay after a heart attack. St. David’s, in Austin, Texas, is operated by HCA Healthcare, the nation’s largest for-profit hospital chain. The teacher’s insurance had paid $56,000 for his out-of-network care. But, the hospital billed the teacher for the difference.

    Fortunately, the story got a lot of media attention. And, shortly after Kaiser Health News and NPR reported it, St. David’s  cut its bill down first to $782.29 and then to $332.29. But, what about all the people with exorbitant medical bills that do not get major media attention?

    What’s particularly noteworthy is that the reduced bill does not reflect St. David’s acknowledgement of billing errors on its part. The hospital’s original bill was intentional. Indeed, the hospital claims it “did everything right in this particular situation.” How? The hospital had let the teacher know that he might be able to get a “discount” on his bill based on his income. 

    The issue, of course, is the legitimacy of St. David’s charges. It stretches credulity that the teacher’s four-day stay could have cost the hospital anything close to the amount it billed. The fact that it slashed the additional charge down to a few hundred dollars immediately after it came to public view also suggests the bill should not have been sent.

    But, in this case, the teacher had insurance through his employer’s self-funded health plan. And, according to Kaiser Health News, ERISA, the federal law concerning self-funded health plans, allows hospitals and doctors to charge patients receiving out-of-network care seemingly whatever they please on top of what their employer plan pays. About six in ten people with employer coverage are enrolled in an ERISA plan.

    Surprise hospital bills are pervasive, particularly when people are seeking emergency care. Some states have stepped in to protect their residents from surprise bills in a limited way. But, not enough. And, Congress has yet to address this serious issue. According to Congressman Lloyd Doggett, “This is a nationwide problem, and we need a nationwide solution.” 

    If your health care coverage is not from your employer through a self-funded ERISA plan, you should be protected from some of these exorbitant surprise bills. The Affordable Care Act permits out-of-network hospitals to bill patients only what they would have paid in an in-network hospital. That said, the ACA still allows out of network ambulances, doctors and hospitals to charge patients for whatever their health plans do not pay.

    If you get surprise medical bills, you should appeal to your health plan to pay them. And, if that does not work, contact your Congressman and Senators as well as your local newspaper and Kaiser Health News to report your story. It’s important to keep the pressure on Congress to address this issue.

    No one should be forced into extreme medical debt or bankruptcy because of a medical or hospital bill, or for that matter, a prescription drug bill. Medicare for All would put an end to these bills. Not surprisingly, the majority of Americans support Medicare for All and an ever increasing cohort of Democrats in Congress do as well.

    If you support Medicare for All, please let Congress know. Sign this petition.

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