President Barack Obama's budget proposal for 2017 includes a provision aimed at protecting consumers from financial hardship if they are hit with unanticipated medical bills, reports Health Affairs.
The practice of balance billing refers to a physician's right to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network or when an insurance company contributes less money for a medical service than anticipated.
Although details are minimal, the president's 2017 budget proposal includes a provision to eliminate the balance billing of privately insured patients. The administration would address the issue by requiring physicians who regularly provide services in hospitals to accept in-network rates for reimbursement, even if they aren't in the insurer's network.
However, federal and state regulators looking to protect consumers from surprise out-of-network medical bills must walk a thin line between two powerful interest groups: physicians and insurers.
Many providers argue the terms balance billing or 'surprise medical bills' largely place unfair blame on providers by construing them as predatory billers. AmericanCollege of Emergency Physicians President Jay Kaplan, MD, said, "Many times what patients perceive as surprise bills are simply the high deductibles that come with low-priced premiums."
Although the president's proposal is unlikely to become law this year, it is a productive springboard for conversations around adequate network coverage and consumer financial protection.
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