This month Congress took the first step to deal with the exploitative practice of “surprise” medical bills.” Legislation is advancing in the House that would protect patients from surprise medical bills and set up the process by which health plans and providers would settle disputed billing amounts.
Both Democrats and Republicans are in agreement about one thing — they don’t like surprise medical bills any more than patients. The bills can occur when a patient is unwittingly treated by doctors and other providers who are not part of their insurance plan’s provider network.
Surprise medical bills can occur when patients are billed for using out - of - network providers even though they may be using an in - network facility. Patients receiving services often think they will only be responsible for the routine co-pay, but then get slapped with enormous bills for the services of out - of - network doctors.
The problem affects Medicare patients enrolled in Medicare Advantage plans when a provider who doesn’t have a contract with their insurance plan charges them the full difference (or balance) between what the insurer approves and what the provider charges. It can also affect patients who are treated by a doctor who does not have a contract with Medicare, although this is more rare — about 90% of all doctors do. Patients have wound up with surprise medical bills that can be in the tens of thousands of dollars.
Research indicates that as many as one-out-of-five visits to emergency rooms, and 16 percent of in-patient hospital admissions, can result in a surprise bill. Almost 85 percent of participants in TSCL’s annual Senior Survey support legislation that would restrict these high bills.
TSCL supports efforts to protect Medicare beneficiaries from surprise medical bills and encourages Congress to continue moving this legislation. How the Senate responds is still up in the air as of this writing, and Medicare Advantage enrollees would still be at risk of getting these abusive bills.
Sources: “Congress’s New Plan to End Surprise Medical Bills, Explained,” Dylan Scott, VOX.com, December 9, 2019. “Ban on Surprise Medical Bills May Pass After All,” Margot Sanger-Katz, The New York Times, December 8, 2019. “Congress Leaves the Surprise Medical Bill Plague Untreated,” USA TODAY, December 23, 2019.
