Surprise billing, one of the most universally reviled aspects of the U.S. healthcare system, may finally soon be banned.
The $900 billion stimulus bill, which includes a wide array of measures like support for small businesses and rental assistance, also includes “bipartisan, bicameral legislation that will end surprise billing for emergency and scheduled care,” according to a joint statement from House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.). Both chambers of Congress are expected to vote on the bill Monday before sending it to President Donald Trump, CNN reported.
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Surprise billing, or balance billing, refers to out-of-network charges that patients must pay, often unexpectedly. Surprise billing can occur in many scenarios, including when a patient goes to an in-network hospital but is treated by an out-of-network provider, The New York Times reported.
In the past two years, one in five insured adults received an unexpected medical bill from an out-of-network provider, according to data published this year in the Journal of the American Medical Association. Two-thirds of adults are worried about affording unexpected medical bills for themselves and their family, and 18% of emergency department visits result in at least one surprise bill.
If passed, the measure included in the stimulus bill would ban health plans, facilities and providers from charging patients for out-of-network costs. Patients would only be required to “pay the in-network cost-sharing amount for out-of-network emergency care, for certain ancillary services provided by out-of-network providers at in-network facilities, and for out-of-network care provided at in-network facilities without the patient’s informed consent.”
Providers and payers would have a 30-day open negotiation period to settle out-of-network claims. If they are unable to reach an agreement, they would enter into a binding arbitration process, where an independent arbiter would help make the final payment decision.
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The surprise billing ban would also prevent patients from being responsible for out-of-network air ambulance bills.
One of the few truly bipartisan issues in healthcare, support for banning surprise bills is widespread. A majority of Democrats and Republicans support government action to protect patients against these surprise bills, the data published in JAMA shows.
Trump has also pushed for an end to the practice, calling on lawmakers to address the unpopular practice in 2019 and issuing an executive order in September that directed Congress to take up the issue before the end of 2020, CNN reported.
On Dec. 11, members from several Congressional committees jointly released a surprise medical billing agreement. That version of the agreement saw opposition from the American Hospital Association and the American Medical Association, with the former stating that it had “significant concerns with several of the provisions that would attempt to implement unworkable billing processes and transparency provisions that are duplicative and costly without clear added benefit for patients.”
America’s Health Insurance Plans, a national association for payers, added in its statement “private equity firms will continue to find ways to exploit the arbitration process to price gouge patients and raise healthcare costs for everyone.”
The latest surprise billing agreement, which is included in the stimulus package, does not differ much from the previous version, with the exception of a few changes, according to Politico. One change is that arbiters would not be able to take Medicare and Medicaid rates into account — which are usually lower than private insurance rates — when making payment decisions.
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