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Wednesday, October 21, 2015

Surprise Medical Bills: Rep. Doggett’s Bill Would Protect Consumers

Shannon Attanasio

Senior Director of Government Affairs

Yesterday, Rep. Lloyd Doggett (D-Texas) introduced the End Surprise Billing Act, legislation to protect health care consumers from surprise medical bills. Families USA is thrilled to endorse this legislation—we’re encouraged that Representative Doggett, along with more than 20 cosponsors, is proposing to address a common problem that affects people across the country.

Surprise bills result when a consumer receives care from an out-of-network provider at an in-network facility

Surprise billing, also known as “balance billing,” occurs when a patient goes to an “in-network” medical facility, but unknowingly receives treatment from a provider outside of his or her insurance plan’s network. As a result, the patient may face much higher bills than he or she would be typically charged for the same care from an in-network provider.  

For example, if a patient goes to an in-network hospital for a surgery, and is unknowingly treated by an out-of-network anesthesiologist, the patient can be forced to pay a large portion of the bill out of his or her own pocket. According to a Consumers Union survey, nearly one-third of privately insured Americans received a surprise medical bill where their health plan paid less than expected in the past two years. 

The End Surprise Billing Act creates protections from unexpected charges for consumers seeking medical care 

Representative Doggett’s bill would ban balance bills from out-of-network providers that treat patients who visit in-network facilities in emergency situations. In non-emergency situations, the bill prohibits an out-of-network provider from charging the consumer a balance bill, unless:

  1. The provider gives the consumer notice 24 hours in advance that the provider is out of network.
  2. The provider gives the consumer an estimate of total charges for treatment and the consumer consents to those charges.

The End Surprise Billing Act is a common-sense policy solution to an all-too-common problem faced by health care consumers. It will help ensure that consumers can get the care they need without fear of facing financial hardship when they seek care in-network, but are unexpectedly treated by an out-of-network provider.

Federal protection would complement action by several states to prevent balance billing

Families USA is calling on members of Congress to add their names as co-sponsors of this legislation. Many states, like New York and Texas, have already begun to address the problem of balance billing on a bipartisan basis, but members of Congress should pass the End Surprise Billing Act to ensure families have federal protection from unexpected medical bills. We urge advocates to contact their representatives and ask them to cosponsor this important legislation.

 

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