April 5, 2019

In This Issue
Fast Facts
NAHU Legislative Council Member Gary Cox Joins Healthcare Happy Hour
House Holds Hearing on Surprise Billing
ACA Affordability Managing Risk
NAHU Coalition Seeks Input on 226J Letters
Submission Deadline for Applicants Seeking Prior Year Coverage through Special Enrollment Periods
State Spotlight: Seeking a North Star in Healthcare Funding Presents a Taxing Situation
Save the Date for the Webinar on FAQs
HUPAC Roundup
What We're Reading
E-mail the Editor
Visit the NAHU Website
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House Holds Hearing on Surprise Billing
On Tuesday, the Education and Labor Subcommittee on Health, Employment, Labor and Pensions held a hearing on surprise billing. This was the first hearing on the subject, with more to hopefully follow.

Surprise billing is a leading healthcare concern and many members of the committee mentioned how their constituents had been negatively impacted by surprise billing recently.

Approximately 20% of emergency room visits involve at least one out of network provider, and about half of ambulances are out of network, with the statistics being worse for air ambulances. Out-of-network providers can charge two to five times the equivalent Medicare rate, and can charge these rates because there are fewer options.

The hearing itself focused on establishing the issue, potential solutions and state models to prevent balance-billing.

Many members when starting their questions mentioned that surprise billing is an issue that is regularly brought to their attention by their constituents. It was established throughout the course of the hearing that:
  • It is nearly impossible for patients to determine if any of their providers are out of network, especially at an in-network hospital.
  • The burden should not be placed on the consumer.
  • Surprise bills can devastate a family or individual financially.
  • Surprise bills can harm families and individuals psychologically due to the stress, and keep them from reaching their potential.
One part of a solution to these issues that was mentioned was transparency—simply knowing which of the providers in network are in-network and which aren’t will improve the issue slightly by providing more information, but it is not able to fix the problem on the whole. If there is only one anesthesiologist in the area, knowing that she is out of network will not prevent a balance-bill, especially if the treatment is emergency.

In short, the solution proposed is to incentivize providers to charge in-network rates or to join the network. Each panelist had their own proposals, but they seemed to agree that Congress needs to step in and determine rules that need to be followed when it comes to out-of-network billing.

The final main subject that was covered during the hearing was the various state plans that have been implemented to decrease surprise billing. According to Professor Hoadley of Georgetown University, there have been 25 states that have implemented plans to remedy surprise billing, though only nine have been comprehensive, including HMO, PPO and ERISA plans. Many representatives asked questions about these nine comprehensive states. Though the preliminary data looks positive, according to the panelists, as of right now the models have not been implemented for a long enough time or on a broad enough scope to get the data on effectiveness that is currently needed.

There is likely to be a bipartisan effort to ameliorate the problem of surprise billing, so we will keep you updated as this process continues.
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