By Adrienne Dresevic, Esq. and Olivia Dresevic, JD expected 2020, of The Health Law Partners, P.C.
For years, Congress has failed to address the issue of surprise billing. This year, however, the issue has gained bipartisan interest and has remained a hot button issue on Capitol Hill. Over the last few months, senate offices have grappled over reaching legislative solutions aimed at handling surprise medical bills. Although most would agree that patients should stop bearing the full cost of surprise billing; the question remains as to who should?
Surprise Billing Background
“Surprise” or out-of-network medical bills arise when a patient receives medical care at a hospital inside their insurance network but is later hit with an enormous bill because those providing the treatment were out-of-network. Patients are generally unaware and believe they are being covered, and these situations oftentimes cannot be avoided (e.g. emergency room services). While surprise medical bills have affected patients for years, the issue gained national attention following Vox’s (an American news and opinion website) extensive investigation into hospital billing which featured thousands of stories of patients who received medical care thinking they were covered only to later be charged thousands of dollars. Some states have enacted, or declined to enact, surprise billing legislation. Recently, however, there has been some movement at the federal level.
2019 Federal Legislative Proposals
In June, the Senate’s Health Committee proposed three options in its discussion draft to curb surprise medical bills. The first option would require hospitals to guarantee patients that all of its physicians were in-network. To fulfill this requirement, physicians could either contract with the hospital’s insurers or remain out of network but submit their charges through the hospital, so the insurer receives only one bill and the hospital incorporates the doctor’s fee. The second option proposed arbitration as a means of resolving disputed charges higher than $750, and the arbiter would review median insurer-negotiated rates from the geographical area as a guide. The third option required that insurers pay the surprise bill at the median contracted rate for that region to the hospital or physician in question.
The “Lower Health Care Costs Act”
The Senate Health Committee landed on a policy that would put a cap on the fees physicians, hospitals, and air ambulances could charge for out-of-network care. In an amended text, committee leaders also tweaked provisions to make the Department of Health and Human Services (HHS) write its regulations according to geographic location, specifically with rural healthcare access in mind. On June 26th, the committee approved the “Lower Health Care Costs Act,” with only three members of the committee voting against the legislation. An additional amendment was proposed following the vote that would make insurers post all physician and hospital options in their networks so patients could view their choices of doctor before deciding on a plan.
Hospitals and physician groups vehemently oppose the benchmark rate cap and continue to push to appoint an arbiter to resolve billing disputes. Insurers and hospitals have also pushed back against the bill’s transparency policies.
Radiology providers and suppliers should stay tuned for more updates regarding federal surprise billing legislation, and look to their respective state laws on the issue.
For more information on issues relating to this article, please contact Adrienne Dresevic, Esq. at (248) 996-8510 or by email at email@example.com.
Adrienne Dresevic, Esq, is a founding shareholder of The Health Law Partners, PC, a nationally recognized healthcare law firm with offices in Michigan and New York. Practicing in all areas of healthcare law, she devotes a substantial portion of her practice to providing clients with counsel and analysis regarding compliance, Stark Law, Anti-Kickback Statute, and compliance related issues. Ms. Dresevic is a member of the American Bar Association Health Law Section’s Council, which serves as the voice of the national health law bar within the ABA. Ms. Dresevic is the Section’s Budget Officer. She also served as the ABA Health Law Section’s Co-Chair of the Physicians Legal Issues Conference Committee. She is licensed to practice law in Michigan and New York, and can be contacted at firstname.lastname@example.org.
Olivia Dresevic, JD expected 2020,, is a law clerk at the Health Law Partners, P.C. She is a rising 3L at Wayne State Law School and is expected to graduate in 2020.
The authors are members of The Health Law Partners, PC and may be reached at (248) 996-8510 or (212) 734-0128, or at www.thehlp.com.