Fight Over Surprise Billing Regulations in Washington

Fight Over Surprise Billing Regulations in Washington

Last year TSCL joined the fight to end “surprise billing,” a practice that generally refers to expensive, unexpected medical bills that patients receive from hospitals and doctors’ offices even when they have health insurance that they expect will cover the majority of the costs of treatment.

It can happen because the patient got treated by a doctor not on the list of providers that contract with that person’s health plan to provide care at negotiated rates. This can happen on visits to a hospital emergency room, when there’s no option of which doctor to see, for example.

Even when patients do seek treatment at a hospital mainly staffed by doctors in their insurance plans, they might wind up being treated by an out-of-network specialist. Worsening the problem, insurers have narrowed their networks of preferred doctors over the years in hopes of steering patients away from hospitals to lower-cost outpatient facilities and doctors.

Another issue known as “balance billing” arises when patients are billed the difference between what a doctor charges for a service and what an insurer is willing to pay for it.

Even patients on Medicare have faced this problem because not all health care providers accept Medicare or some Medicare supplement policies.

Congress passed legislation to end the practice at the end of the year, but as with so much other legislation Congress passes, it gave an outline of new policy but it left a great deal up to the President to work out the specifics.

Now, a new fight over the practice has emerged as Health groups and consumer advocates are mounting a lobbying campaign to shape forthcoming federal rules around the ban.  These are the same health groups that fought bitterly during the law’s drafting about who would pick up the costs they could no longer bill to patients.

The groups that have begun lobbying the administration include large hospital systems and health insurers, major trade associations, air ambulance companies and private equity-backed physician staffing firms.

They have already spent heavily on lobbying and are expected to soon intensify their efforts, and TSCL’s concern is that the new protections could be watered down during the rulemaking process and leave consumers still vulnerable to unexpectedly large bills.

The task for the Administration is to figure out how to ensure patients don’t unknowingly sign away their new protections, monitor and punish providers who violate the ban, and establish a process for settling disputes, among other complicated considerations. The ban is due to take effect in January.

This is an issue TSCL will continue to monitor as the year progresses to make sure the legislation is implemented as Congress intended.