A bipartisan group of U.S. Senators has introduced the Protecting Patients from Surprise Medical Bills Act, which would shield patients covered through self-funded insurance plans from high charges and unexpected medical bills.
“Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame,” said Sen. Bill Cassidy, MD (R-LA), one of the bill’s cosponsors along with Sens. Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN) and Claire McCaskill (D-MO).
The legislation targets the practice of “balance billing,” under which patients may be held responsible for paying the difference when a self-insurance plan and an out-of-network health-care provider cannot agree on the cost of care. Many states protect patients from balance billing, but these laws do not apply to self-funded plans, allowing hospitals to bill patients for the disputed amount. In some cases, patients have received unexpected bills of tens of thousands of dollars for out-of-network or emergency care.
The proposed legislation mandates that patients receiving this type of care only pay the amount required by their insurance plan out of pocket; patients would not be responsible for any discrepancy between the medical bill and the insurance payout. The bill similarly would protect patients treated by out-of-network doctors at hospitals within the patients’ networks, such as emergency department physicians who are not employees of the hospital, and would mandate that emergency patients, once stabilized, be informed when their insurance may not protect them from excess charges.
“Increasing transparency is one of the most important steps we must take to improve our health care system,” said Sen. Bennet. “Patients deserve to know how much they are paying for health care services and procedures at the point of care.”