Families USA Endorses Plan to Curb “Surprise” Medical Bills Introduced Yesterday in Congress

Washington, D.C. – Families USA endorses proposed federal legislation, introduced yesterday by U.S. Rep. Lloyd Doggett, to protect consumers from “surprise” medical bills that can add up to thousands of dollars for out-of-network services delivered in in-network facilities.

The bill has 20 cosponsors.

“This is an extremely important consumer protection that cries out for national legislation,” said Ron Pollack, executive director of Families USA. “The way it stands now, a consumer can do all the homework asked of them, know with certainty the facility they are checking into is part of their insurance network, and still check out with thousands of dollars in charges for out-of-network services from medical specialists they often never even met, let alone consented to be treated by.”

When consumers go to in-network hospitals in an emergency or for a scheduled procedure, they may find that even though those hospitals accept their insurance, specific providers working in the hospitals do not. For example, anesthesiologists, emergency physicians, pathologists, and other specialists who may treat them during the course of their care may be out of network. Consumers often don’t realize this until the surprise medical bills – also known as “balance bills” – come in and they are faced with steep out-of-network charges.

Under the “End Surprise Billing Act,” patients can no longer be charged balance bills if they go to an in-network facility in an emergency. In non-emergencies, they cannot be balanced billed unless they are given 24-hours-notice that an out-of-network specialist is providing care, an estimate of the charges, and then provide written consent to those charges. If these conditions are not met, the patient is only responsible for what they would have paid for those services if they received them from an in-network provider.

According to a Consumers Union survey, in the past two years nearly one-third of privately insured Americans received a surprise medical bill, in which their health plan paid less than expected. Several states, including California and Texas, have already enacted laws to help address surprise bills or are considering them.

“When states as different politically as New York and Texas enact similar laws, you know there is the making for bipartisan consensus in Congress,” Pollack said. “Families USA urges all 535 member of Congress to take a serious look at the “End Surprise Billing Act,” consider the interests of the people they represent, and then sign on as cosponsors.”