NAHU and seven other industry stakeholders founded the Coalition Against Surprise Medical Billing, a partnership representing employers, physicians and health plans to advance reforms that would protect patients from exorbitant medical charges from out-of-network providers. This remains one of the top healthcare issues that both Republicans and Democrats want to address this year, demonstrated through the release of numerous bills, both formally introduced and currently in discussion draft form. The coalition is planning an advertising campaign to reinforce the need for meaningful consumer protections and avoiding policy reforms such as arbitration.
Surprise medical billing, or “balance billing” of out-of-network medical care, is one of the most pressing health and affordability challenges facing patients and their families, with millions of Americans receiving unexpected and unaffordable medical bills every year. These bills often include exorbitant charges that are far greater than in-network rates and can cost consumers thousands or even tens of thousands of dollars. According to a recent Kaiser Family Foundation poll, 41% of insured adults ages 18-64 said they received a surprise bill in the last two years.
The coalition is advocating federal legislation that would provide new patient safeguards related to emergency care while also implementing a federal payment benchmark for out-of-network provider rates as an alternative to arbitration proposals. Establishing a federal benchmark would ensure patients who are treated by out-of-network providers, largely clinical specialists and hospitals that opt against participating in-network, still benefit from negotiated rates. This would also avoid the arbitration process that can lead to an increase in premiums that are ultimately paid by consumers and employers. It is estimated that implementing such a benchmark could save consumers more than $25 billion over ten years.
The coalition supports meaningful improvements that would: protect patients and families from surprise medical bills; maintain fair and equitable payments for providers with a federal benchmark standard; and help reduce consumers’ health insurance premiums by avoiding a costly arbitration process and addressing the inflated bills that make health care more expensive. We are advocating four primary solutions to curb the practice of surprise billing:
- Ban balance-billing when patients inadvertently see out-of-network providers.
- Reimburse providers based on the negotiated rate for that service.
- Establish an independent dispute resolution process, but not arbitration.
- Require hospitals disclose out-of-network physicians in non-emergencies.
Along with NAHU, the coalition is comprised of America’s Physician Groups, America’s Health Insurance Plans, American Benefits Council, Blue Cross Blue Shield Association, ERISA Industry Committee, HR Policy Association and National Retail Federation. We expect more consumer groups, business groups and organized labor to join in the coming weeks.
NAHU is committed to working with policymakers at both the federal and state levels to address the issue of surprise and balance medical bills. The NAHU legislative council includes a special balance billing working group aimed at identifying potential solutions and proposing these to policymakers. The working group recently finalized an infographic to help explain the issue of balance billing and the actions that are needed by Congress. For more information on surprise billing issues, and a look at the New York version of arbitration, listen to our podcast with NAHU Balance Billing Working Group member Gary Cupo and attorney John Fanburg.