State, Federal Officials Work To Curb Surprise Billing

By Consumers For Quality Care, on March 13, 2019

Consumers often face surprise medical bills after receiving care from an out-of-network provider at an in-network facility.

Even when consumers are vigilant, they can end up with surprise bills. This was true for Khrystyna Greene, who went to a free-standing emergency room in San Antonio to get care for her son who had fallen and cut his head. At the ER, she asked if her Blue Cross and Blue Shield of Texas insurance would cover the care, The Houston Chronicle says. The staff told her it would.

“Are you positive?” she pressed, asking if everything was in-network since she had been burned before by an out-of-network bill. She was told she only had to pay the $600 emergency room co-pay, which her mother-in-law did on the spot.

Six weeks later, she received a surprise medical bill for nearly $1,200. The emergency room was in-network, but the doctor who treated her son was not. Greene’s insurance did not cover any part of the visit.

Following countless similar consumer experiences with surprise bills, , lawmakers around the country are working to prevent such situations in the future.

At the federal level, Sen. Bill Cassidy (R-La.) told The Hill that a bipartisan group of senators hope to release draft legislation this month to end surprise bills. The group includes Sens. Michael Bennet (D-CO) and Maggie Hassan (D-NH). Bennet said lawmakers are currently looking at feedback they have received from outside groups, including providers, insurers, consumer groups, and employers.

“I am pleased that we are all working together across party lines to draft a bill that will help end the absurd practice of surprise medical bills and take the patient out of the middle of these disputes,” Hassan said in a statement.

In California, state Assemblyman David Chiu and state Sen. Scott Wiener have introduced legislation that would prohibit hospitals from billing consumers who receive emergency room care for more than their regular copay or deductible, even if the hospital is out-of-network, among other provisions aimed at protecting consumers.

In Texas, a bipartisan group of state lawmakers has introduced legislation that aims to end balance billing. The bill would force insurers and providers to mediate payment disputes before sending a balance bill to consumers, KUT reports. Texas has some of the highest instances of surprise billing in the country, with 27 percent of patients likely to receive a surprise bill for emergency room care. The national average is 14 percent.