Lawmakers Introduce Legislation To Curtail Surprise Medical Bills

There are good surprise and there are bad surprise. Falling into the latter category are unexpected medical bills, which affect nearly 30% of privately insured Americans. This week, lawmakers took steps to shield consumers from these often burdensome tabs. 

Texas Representative Lloyd Doggett, along with 20 co-sponsors, introduced the Ending Surprise Billing Act with the aim to put a stop to unfair and unexpected out-of-network charges.

Under the proposed legislation, patients can no longer be charged balance bills if they go to an in-network facility in an emergency.

In the case of non-emergencies, they cannot be balanced billed unless they are given 24-hours-notice that an out-of-network specialist is providing care, an estimate of the charges, and then provide written consent to those charges.

If the conditions of the legislation aren’t met, patients would only be responsible for what they would have paid for services if they received them from in-network providers.

“Patients under anesthesia shouldn’t have to pay out-of-pocket unexpectedly for a health care provider outside their insurance coverage network,” Doggett said in statement. “Surprise billing is a complex problem. But we should all agree that requiring patients to pay unfair and unexpected bills is not the solution.”

Consumer advocates were quick to applaud the introduction of the bill.

Our colleagues at Consumers Union, who are running a campaign to end surprise medical bills, called the legislation an important step in protecting consumers.

“The unfortunate fact is that thousands of consumers across the country are hit with surprise medical bills, even when they’ve done their due diligence to find hospitals and doctors covered by their insurance plans,” Betsy Imholz, Director of Special Projects for Consumers Union, said in a statement. “This legislation is an important step in taking the ‘surprise’ out of surprise medical bills and ensuring that consumers aren’t on the hook for unexpected charges, especially in emergency situations.”

Families USA also endorsed the legislation, noting that the issue “cries out for national legislation.”

“The way it stands now, a consumer can do all the homework asked of them, know with certainty the facility they are checking into is part of their insurance network, and still check out with thousands of dollars in charges for out-of-network services from medical specialists they often never even met, let alone consented to be treated by,” Ron Pollack, executive director of Families USA, said in a statement.

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  1. Thorzdad2 says:

    This is actually a great idea for a bill. Consumers often don’t understand that, just because the hospital is in-network, that doesn’t mean any of the doctors are. Except for a handful of nurses, most doctors in a hospital are independent contractors, often part of large medical groups, and not hospital employees.

    And, even when you’re going in for elective surgery, your surgeon might be in-network but the anesthesiologist (who is often the most expensive doctor in the room) might not be.

    This is such a great idea, though, that I fully expect it to not go anywhere, after it’s bogged-down by umpteen attachments calling for the repeal of the Affordable Care Act. Because, that’s how Washington rolls.