A recent Kaiser Family Foundation poll finds that surprise medical bills top the list of financial fears for American families:
Surprise medical bills can be astonishingly large, as when Drew Calver, who thought he was fully insured, received a bill for $109,000 for emergency treatment of a heart attack – more than twice his annual salary as a high school teacher.
Surprise medical bills for insured patients most often occur in two situations. One (as in Calver’s case) is emergency treatment at a hospital that is not in the insurer’s network. The other is complex treatment, as for a joint replacement or transplant, which is undertaken at an in-network hospital but with the assistance of some out-of-network participants, such as a radiologist or anesthesiologist. Patients typically do not get to choose these practitioners, and often are unaware of their participation until bills arrive.
An increasing number of states have laws protecting patients from surprise medical bills, but even in those states, there are loopholes. One big loophole concerns certain employer-sponsored insurance plans that are regulated at the federal level. Federal law currently offers no protection against surprise bills.
In September, a bipartisan group of six Senators – Michael Bennet (D-CO), Tom Carper (D-DE), Bill Cassidy (R-LA), Chuck Grassley (R-IA), Claire McCaskill (D-MO), and Todd Young (R-IN) – introduced draft legislation that would offer the needed protection. An analysis by the Brookings Institution summarizes the main provisions of the draft legislation, and offers some suggestions for resolving potential problems.
If enacted, the bill would limit patient cost-sharing to the amount they would owe to an in-network provider; set a payment standard regarding what insurers owe providers in these situations; and, prohibit providers from balance billing patients.
The Brookings analysis provides numerous links to further discussion of the issue of surprise medial bills.