“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.

Related: Majority of people have received unexpected medicalbills in the past year

Kevin Lucia, a senior research professor at GeorgetownUniversity's Center on Health Insurance Reforms who had not yetread the draft legislation, said the measure was aimed at a bigproblem.

“Balance billing is ripe for a federal solution,” he said.States regulate only some health plans and that “leaves open a vastnumber of people that aren't covered by those laws.”

Federal law regulates health plans offered by many largercompanies and unions that are “self-funded.” Sixty-one percent of privately insured employees get theirinsurance this way. Those plans pay claims out of their own funds,rather than buying an insurance policy. Federal law does not prohibit balance billing in these plans.

Cassidy's office said, however, that this legislation would plugthat gap.

In addition to Cassidy, the legislation is being offered by Sens. Michael Bennet (D-Colo.),Chuck Grassley (R-Iowa), Tom Carper (D-Del.), Todd Young (R-Ind.)and Claire McCaskill (D-Mo.).

Cassidy's announcement cited two recent articles from KaiserHealth News and NPR's “Bill of theMonth” series, including a $17,850 urine test and a $109,000 bill after a heart attack.

In a statement to Kaiser Health News, Bennet said, “In Colorado,we hear from patients facing unexpected bills with astronomicalcosts even when they've received a service from an in-networkprovider. That's why Senator Cassidy and I are leading a bipartisangroup of senators to address this all-too-common byproduct oflimited price transparency.”

Emergency rooms and out-of-network hospitals aren't the onlysources of balance bills, Lucia said. He mentioned that both groundand air ambulances can leave patients responsible for surprisinglyhigh costs as well.

Lucia said he was encouraged that both Democrats and Republicanssigned on to the draft legislation.

“Any effort at the federal level is encouraging because this hasbeen a challenging issue at the state level to make progress on,”Lucia said.

KHN reporter Carmen Heredia Rodriguez contributed to thisarticle.

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

Read more about the problem withbalance-billing:

• More states cracking down onbalance-billing
• Out-of-network providers vex large employerplans
• Fighting back against “surprise” medicalbills