Surprise medical billing has become a key focus for federal and state lawmakers this year.
The issue was first thrust into the spotlight in January when President Donald Trump vowed to end medical bills that leave patients with high, unexpected out-of-pocket costs.
Since then, the U.S. House and Senate have continued efforts to find a legislative solution, with multiple proposals unveiled this month.
Meanwhile, state lawmakers have also approved surprise-billing laws. At least 26 states now have laws protecting patients from surprise out-of-network bills, according to NBC-affiliate TV station KGW.
With this issue at the forefront, Becker's Hospital Review recently caught up with Chip Kahn, president and CEO of the Federation of American Hospitals, to get his thoughts on surprise medical bills and the legislative efforts underway.
Three takeaways:
1. Two separate issues. From Mr. Kahn's perspective, surprise medical bills involve two separate issues. He said the first is when a patient is transported to a hospital emergency room that is outside their health plan's network, and there aren't clear rules about the person's cost-sharing and out-of-pocket costs. The other is when an out-of-network provider, such as a radiologist or anesthesiologist, treats a patient at an in-network facility. The separation is important, Mr. Kahn said, because the implications of one solution don't help solve the implications of the other.
2. Perception problem. As more Americans have high-deductible health plans, many bills may be considered a "surprise" to patients, said Mr. Kahn. They may not realize they owe as much as they do until they get the bill. "I think the way healthcare works is sometimes a big surprise [for patients]," he said. "It shouldn't be because people can look at their benefits even if [the facility is] in-network and see that if they go to a hospital, they will usually have a big deductible or a big copay. So, I think it's always difficult with people."
3. Hard issue to solve. The issue of surprise medical bills is hard to solve at the federal level because healthcare stakeholders have different positions. The White House has proposed hospital "bundled billing" that aims to ensure patients don't receive separate out-of-network bills. But physician and hospital groups, including the Federation of American Hospitals, American Hospital Association and American Medical Association, have come out againstthe idea.
Hospital groups have indicated they think patients should be protected by ensuring their cost-sharing is based on an in-network rate. Once protections are in place, providers generally support independent arbitration to settle disputes between insurers and providers by determining whether the amount the physician is charging or the amount the insurer is agreeing to pay is fairer, according to The Hill. Insurers reportedly don't favor arbitration, though, and want Congress to set reimbursement rates.
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