“Balance billing is ripe for afederal solution,” says one expert, noting that current healthplan regulation “leaves open a vast number of people that aren'tcovered by those laws.” (Photo: Shutterstock)

With frustration growing among Americans who are being chargedexorbitant prices for medical treatment, abipartisan group of senators Tuesday unveiled a plan to protectpatients from surprise bills and high charges from hospitalsor doctors who are not in their insurance networks.

The draft legislation, which sponsors said is designed toprevent medical bankruptcies, targets three keyconsumer concerns:

  1. Treatment for an emergency by a doctor who is not part of thepatient's insurance network at a hospital that is also outside thatnetwork. The patients would be required to pay out-of-pocket theamount required by their insurance plan. The hospital or doctorcould not bill the patient for the remainder of the bill, apractice known as “balance billing.” The hospital and doctor couldseek additional payments from the patient's insurer under stateregulations or through a formula established in thelegislation.
  2. Treatment by an out-of-network doctor or other provider at ahospital that is in the patient's insurance network. Patients wouldpay only what is required by their plans. Again, the doctors couldseek more payments from the plans based on formulas set up by staterules or through the federal formula.
  3. Mandated notification to emergency patients, once they arestabilized, that they could run up excess charges if they are in anout-of-network hospital. The patients would be required to sign astatement acknowledging that they had been told their insurancemight not cover their expenses, and they could seek treatmentelsewhere.

“Our proposal protects patients in those emergency situationswhere current law does not, so that they don't receive a surprisebill that is basically uncapped by anything but a sense of shame,”Sen. Bill Cassidy (R-La.) said in his announcement about the legislation.

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