AHIP, healthcare organizations, advocate for federal standard to prevent surprise medical bills

Nine healthcare organizations including America's Health Insurance Plans have joined to support federal legislation to end surprise medical bills.

Payments to out-of-network doctors should be based on a federal standard, the groups said. The federal policy should protect consumers from surprise bills while restraining costs and ensuring quality networks, the groups said.

Patients should be informed when care is out-of-network and they have the right to know the cost of their treatment and options. No policy should increase premiums or other costs for consumers, the groups said.

The organizations are America's Health Insurance Plans, American Benefits Council, Blue Cross Blue Shield Association, Consumers Union, The ERISA Industry Committee, Families USA, National Association of Health Underwriters, the National Business Group on Health and the National Retail Federation.

WHY THIS MATTERS

Surprise medical bills can add up to tens of thousands of dollars for patients, who are expected to pay the bill out-of-pocket.

Health insurers develop networks to negotiate better value and lower costs for the consumers they serve, the groups said. When doctors, hospitals, or care specialists choose not to participate in networks – or if they do not meet the standards for inclusion in a network – they charge whatever rates they like.

The consequence is millions of consumers receiving surprise, unexpected medical bills and blaming their insurer or provider.

THE TREND

Surprise bills come from services provided by physicians who are out-of-network for a patient's insurance coverage. Patients may not realize they are getting care from a provider who is not in network, particularly from an emergency room physician. It's not unusual for hospitals to contract for ER physician services.

An estimated 20 percent of emergency department visits and resulting admissions at in-network facilities involved an out-of-network physician, according to studies published last year in Health Affairs and The New England Journal of Medicine.

Surprise, out-of-network bills hurt consumers, but these studies show these bills undermine competition between health insurance plans and harms plans that are trying to limit costs by offering narrower network products.

According to a recent poll from Kaiser Family Foundation, one in 10 insured adults ages 18-64 say they received a surprise medical bill from an out-of-network provider in the past year, the groups said.

ON THE RECORD

"Every American deserves affordable, high-quality coverage and care, as well as control over their own health care choices," the groups said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com