H.R. 861 would require any hospital seeking to participate in Medicare to provide any out-of-network insured patients with detailed out-of-network cost notices. (Photo: Shutterstock)
While Congress is rightfully considering ways to ban balance billing when patients receive treatment for emergency care and for care at in-network facilities, more can be done to protect patients from surprise medical bills, according to the National Business Group on Health.
The trade association representing 448 primarily large employers submitted a comment letter to the House Ways and Means subcommittee, to be placed on record as written testimony for the subcommittee's hearing last month on limiting surprise medical bills for patients.
The subcommittee's chair, Rep. Lloyd Doggett, D-Texas, is trying to round up support for H.R. 861, a bill that would require any hospital seeking to participate in Medicare to provide any out-of-network insured patients, whether the patients were covered by Medicare or by other health insurance programs, with detailed out-of-network cost notices.
The notices would have to warn the patients about the likelihood that they would be getting care out of network, and explaining what kinds of bills they might end up having to pay.
A hospital that wanted to be part of Medicare and failed to provide a balance billing warning notice could bill an insured patient only for the cost-sharing amount the patient would have owed if the care had been provided by an in-network provider.
If a hospital in the Medicare program provided emergency care to an insured patient outside of the patient's health plan network, the hospital could bill the patient only for the patient's usual in-network cost-sharing amounts.
Additional draft bills addressing balance billing have been proposed by other committees, including the Senate HELP Committee.
In its comment letter, NBGH applauded lawmakers for proposing ways to ban balancing billing, but said there are “major differences” among the proposals that impacts how completely they protect patients.
“Some proposals would build in inflationary pressure on patient and plan participant premiums from charges reflecting the undue market leverage of specific facility-based physicians, by establishing benchmark payment rates that are too high or setting up an arbitration scheme that tilts to their advantage,” the group wrote.
This would also encourage more physicians to treat people out of their networks, because they would be able to charge higher payments—hurting both patients and their employer plans, according to NBGH.
The group also urged lawmakers to find ways to reduce the number of situations in which surprise bills can occur, such as mandating “network matching.”
“Requiring facility-based physicians to either contract with the same insurers that facilities they practice in do, or by prohibiting separate billing for ancillary services apart from the facilities, will significantly reduce the number and frequency of surprise bills,” NBGH wrote.
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
