Not everyone likes surprises. And not all surprises are good. Take surprise medical bills, for instance—it seems that nobody is happy to receive one of those in the mail. Unfortunately, they’re more and more common these days, and that means you should prepare your clients in case they receive a surprise bill following a medical procedure.
What is a surprise medical bill?
Put simply, a surprise medical bill is one that the patient wasn’t expecting, usually because he or she was careful to stay in-network for a planned procedure or assumed a procedure would be covered by insurance. As a lot of people find out, though, most doctors who work in a hospital do not necessarily work for the hospital, and even when a hospital is in-network for a particular health plan, many of these hospital-based physicians choose not to join the contracted provider network.
Without agreeing to contracted rates ahead of time, these providers are free to “balance-bill” the member after the insurance company pays what it considers to be a “reasonable and customary” amount. The four categories of physicians who most frequently send surprise medical bills to their patients are anesthesiologists, pathologists, radiologists, and emergency room physicians.
A big problem
The most recent Kaiser Family Foundation tracking poll finds that unexpected medical bills are a big worry for many Americans, ranking higher than insurance premiums and deductibles. According to the report, “Four in ten insured adults ages 18-64 say there has been a time in the past 12 months when they received an unexpected medical bill, and one in ten say they received a ‘surprise’ medical bill from an out-of-network provider in the past year.”
An extreme case
In August, NPR published an article about a schoolteacher in Austin who was left with a charge of $108,951 following a heart attack, and that’s after his health plan had paid $55,840. A bill like that is enough to give him another heart attack…
Following the article, which gained national attention, the hospital agreed to settle the balance bill for just $782, but this story illustrates how big the problem is and why so many people are calling on Congress for a solution.
A bipartisan bill
The good news is that there is a bill with bipartisan support that would help to solve at least part of the problem. As The Hill reports, the bill, which is sponsored by Sen. Bill Cassidy (R-La.) and other lawmakers, “would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan.” Moreover, any “additional charges, which are limited under the proposal,” would be paid by the insurance company, not the patient. The bill would also prevent patients from being “charged more for care from out-of-network doctors at an in-network hospital.”
While it is encouraging that both Democrats and Republicans are supportive of this legislation, its passage is not a sure thing. In fact, Senator Cassidy says he will not push for the bill’s consideration until the next session of Congress, which begins in January—after the mid-terms. The recent election may also help to move this bill forward in the next session of Congress too.