“Surprise bills” are health care bills that patients didn’t know were coming. These bills can be much higher than normal copays or coinsurance that consumers pay, and they have led to financial hardship and even ruin for some patients. The issue stems from when consumers choose in-network hospitals and believe that the physicians who work at the hospital are in-network. However, sometimes the treating physician has contracted with the hospital, but not the insurance company and the patient has then unknowingly been treated by an out-of-network provider. The health insurance company will usually pay a portion of what the out-of-network provider billed, and then the physician bills the patient for the remaining amount, which is typically much higher than they would pay for in-network services. During this difficult time of an unprecedented global pandemic, when people are out of work and at-risk of not even being able to pay for medical bills, it is even more important that patients know that they will not have surprise bills. Anybody with COVID-19 symptoms should be able to go to their doctor and in-network hospital for testing and treatment without fear of the costs.
Before the outbreak, there were a number of studies that showed that surprise bills hurt consumers and are a growing problem. Out-of-network physicians can work at emergency departments or can assist the surgeon during a surgery by being the anesthesiologist or radiologist. One investigation showed that one out of five emergency department visits involved care from an out-of-network provider.1 Another study showed that the specialties most likely to balance bill are those who assist in surgeries in the hospital (anesthesiology, radiology, etc.).2 Hence, even consumers who have checked to make sure that their hospital and surgeon are in-network can still receive a surprise bill. The bills often occur when consumers are most vulnerable and least able to make certain decisions, such as being rushed into an emergency department because of a life-threatening emergency or when getting ready to go into surgery. There is no federal law that prohibits balance billing in the commercial market. Too many patients are facing surprise bills. Please urge Congress to include language in the next COVID-19 federal aid package that protects patients from surprise bills and holds them financially harmless from out-of-network costs that they could not control.
1 Copper, Zack, Fionia Scott Morton. 2016. “Out-of-network emergency-physician bills-an unwelcome surprise.” NEJM 2016; 375:1915-1918. https://www.nejm.org/doi/full/10.1056/NEJMp16085712 Bai G, Anderson GF. Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region. JAMA. 2017;317(3):315318. doi:10.1001/jama.
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Please enact legislation that protects kidney patients from "Surprise Bills"
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