Congress Letting Our Nation Down: New Poll Shows Nearly 90% of Voters Want Congress to Act Immediately to Pass Legislation to Protect Patients from Surprise Medical Bills

Wednesday, November, 13th, 2019

https://familiesusa.org/press-releases/congress-letting-our-nation-down-new-poll-shows-nearly-90-of-voters-want-congress-to-act-immediately-to-pass-legislation-to-protect-patients-from-surprise-medical-bills/

Congress Needs to Act Immediately to Stop Surprise Medical Bills, Says National Campaign

Thursday, September, 26th, 2019

https://familiesusa.org/press-releases/congress-needs-to-act-immediately-to-stop-surprise-medical-bills-says-national-campaign/

Oppose the Ruiz Amendment and Support the Underlying Surprise Billing Legislation

Wednesday, July, 17th, 2019

https://familiesusa.org/press-releases/statement-oppose-ruiz-amendment-and-support-underlying-surprise-billing/

Senate Leaders Put People before Politics with Bipartisan Effort to Address Surprise Medical Bills and other Health Priorities

Wednesday, June, 19th, 2019

https://familiesusa.org/press-releases/statement-senate-leaders-put-people-politics-bipartisan-effort-address-surprise/

Families USA applauds members of the U.S. Senate Bipartisan Working Group for introducing the STOP Surprise Medical Bills Act

Friday, May, 17th, 2019

https://familiesusa.org/press-releases/statement-families-usa-applauds-members-us-senate-bipartisan-working-group/

Energy and Commerce Committee‘s Draft Legislation Will Provide Critical Protection for Consumers from Surprise Medical Bills

Wednesday, May, 15th, 2019

https://familiesusa.org/press-releases/statement-energy-and-commerce-committees-draft-legislation-will-provide-critical-protection-for-consumers-from-surprise-medical-bills/

Frederick Isasi Will Testify at the House Education and Labor Committee Hearing on Surprise Medical Bills– Will Tell Congress that “Distorted Economic Incentives in the Health Care Sector are Overwhelming the Interests of Patients and Families”

Monday, April, 1st, 2019

https://familiesusa.org/press-releases/statement-frederick-isasi-will-testify-at-the-house-education-and-labor-committee-hearing-on-surprise-medical-bills-will-tell-congress-that-distorted-economic-incentives-in-the-heal/

Michigan’s surprise billing legislation attracts national attention

Sunday, September, 13th, 2020

MiBiz

https://mibiz.com/sections/health-care/michigan-s-surprise-billing-legislation-attracts-national-attention

3rd Hour of TODAY: The biggest questions over medical bills during the coronavirus pandemic, including what’s covered by insurance and what isn’t

Thursday, July, 23rd, 2020

 

Surprise Billing Spending Ends Amid Congressional Deadlock

Thursday, July, 23rd, 2020

Bloomberg Law

https://news.bloomberglaw.com/coronavirus/surprise-billing-spending-ends-amid-congressional-deadlock

The Forces Fighting Congress’s Bill To End Surprise Billing Are Acting Like They’ve Already Won. They Likely Have.

Friday, July, 10th, 2020

Buzzfeed News

https://www.buzzfeednews.com/article/paulmcleod/surprise-billing-legislation-dying-in-congress

 

In Fine Print, HHS Seems To Have Banned Surprise Medical Bills During The Pandemic

Monday, April, 20th, 2020

NPR

https://www.npr.org/sections/health-shots/2020/04/17/837749925/in-fine-print-hhs-seems-to-have-banned-surprise-medical-bills-during-the-pandemi

Why Congress Can’t Stop Surprise Medical Bills

Tuesday, April, 7th, 2020

Washington Monthly

https://washingtonmonthly.com/magazine/april-may-june-2020/why-congress-cant-stop-surprise-medical-bills/

Surprise Billing Curb May Hitch Ride on Next Coronavirus Bill

Tuesday, March, 31st, 2020

Bloomberg Law

https://news.bloomberglaw.com/health-law-and-business/surprise-billing-curb-may-hitch-ride-on-next-coronavirus-bill

What Is The Cost Of COVID-19 Treatment?

Sunday, March, 29th, 2020

NPR

https://www.nprillinois.org/post/what-cost-covid-19-treatment#stream/0

 

Creating the Price Transparency Patients Deserve

Wednesday, March, 25th, 2020

Health Leaders Media

https://www.healthleadersmedia.com/finance/creating-price-transparency-patients-deserve

 

House committees’ move surprise billing legislation ahead of May deadline

Saturday, February, 15th, 2020

Modern Healthcare

https://www.modernhealthcare.com/politics-policy/house-committees-move-surprise-billing-legislation-ahead-may-deadline

 

 

House committee advances provider-friendly surprise billing fix

Wednesday, February, 12th, 2020

Modern Healthcare

https://www.modernhealthcare.com/politics-policy/house-committee-advances-provider-friendly-surprise-billing-fix

House Looks At Surprise Billing Proposals

Monday, February, 10th, 2020

Insurance News Net

https://insurancenewsnet.com/innarticle/house-looks-at-surprise-billing-proposals#.XkW06WhKg2w

House committees unveil surprise billing legislation

Friday, February, 7th, 2020

The Hill

https://thehill.com/policy/healthcare/overnights/482093-overnight-health-care-new-surprise-billing-legislation-released

US families hit with huge surprise medical bills: What can be done.

Wednesday, January, 15th, 2020

Nightline

https://abcnews.go.com/Nightline/video/us-families-hit-huge-surprise-medical-bills-68321419?cid=clicksource_574_null_card_image

Congress will try to score drug pricing, surprise billing wins in 2020

Friday, January, 3rd, 2020

Modern Healthcare

https://www.modernhealthcare.com/politics-policy/congress-will-try-score-drug-pricing-surprise-billing-wins-2020

Demand for Medical Cost Transparency Spurs Change

Monday, December, 23rd, 2019

Web MD

https://www.webmd.com/health-insurance/news/20191223/demand-for-medical-cost-transparency-spurs-change

Welcome to the Club (That You Don’t Want to Join)

Wednesday, December, 18th, 2019

ABC Radio

https://podcasts.apple.com/us/podcast/start-here/id1355180130?i=1000459956432

Surprising Swings In Momentum For Legislation On Surprise Medical Bills

Tuesday, December, 17th, 2019

Kaiser Health News

https://khn.org/news/congress-compromise-legislation-on-surprise-medical-bills/

Top Dem Accused of Putting Private Equity Before Sick and Poor by Killing Effort to End ‘Devastating’ Surprise Medical Bills

Tuesday, December, 17th, 2019

Common Dreams

https://www.commondreams.org/news/2019/12/17/top-dem-accused-putting-private-equity-sick-and-poor-killing-effort-end-devastating

Congress Likely to Punt Surprise Billing Legislation to 2020

Tuesday, December, 17th, 2019

Medscape

https://www.medscape.com/viewarticle/922754

Turf war derails bipartisan push on surprise medical bills

Friday, December, 13th, 2019

The Hill

https://thehill.com/policy/healthcare/474520-turf-war-derails-bipartisan-push-on-surprise-medical-bills

Congress’s new plan to end surprise medical bills, explained

Tuesday, December, 10th, 2019

Vox

https://www.vox.com/policy-and-politics/2019/12/9/21003480/stop-surprise-medical-bills-legislation

Competing House surprise billing plan muddies path of White House-backed legislation

Monday, December, 9th, 2019

Healthcare Dive

https://www.healthcaredive.com/news/competing-house-surprise-billing-plan-muddies-path-of-white-house-backed-le/568682/

House lawmakers may revive provider-friendly surprise billing proposal

Wednesday, December, 4th, 2019

Modern Health Care

https://www.modernhealthcare.com/politics-policy/house-lawmakers-may-revive-provider-friendly-surprise-billing-proposal

Crunch time for Congress on surprise medical bills

Monday, November, 25th, 2019

The Hill

https://thehill.com/policy/healthcare/471405-crunch-time-for-congress-on-surprise-medical-bills

Groups Try To Renew Momentum On ‘Surprise’ Bill Legislation

Friday, November, 15th, 2019

Politico

https://www.politico.com/newsletters/politico-pulse/2019/11/14/new-price-transparency-rules-landing-tomorrow-782422

Poll aims to reignite federal surprise-billing debate

Thursday, November, 14th, 2019

Becker’s Hospital Review

https://www.beckershospitalreview.com/finance/poll-aims-to-reignite-federal-surprise-billing-debate.html

Nearly half of Americans say they’ve been hit with a surprise medical bill

Thursday, November, 14th, 2019

Vox

https://www.vox.com/policy-and-politics/2019/11/13/20961663/poll-stop-surprise-medical-bills-legislation

It can happen to anyone of us, an air ambulance ride costing $53,000

Thursday, August, 15th, 2019

News 5 Cleveland- TV

https://www.news5cleveland.com/news/local-news/investigations/diagnosis-debt/it-can-happen-to-anyone-of-us-an-air-ambulance-ride-costing-53-000

Politicians Tackle Surprise Bills, but Not the Biggest Source of Them: Ambulances

Monday, July, 22nd, 2019

The New York Times

https://www.nytimes.com/2019/07/22/upshot/ambulance-surprise-medical-bills-law.html

House Panel Strikes Deal On Surprise Billing

Thursday, July, 18th, 2019

POLITICO

https://www.politico.com/newsletters/politico-pulse/2019/07/18/much-loathed-cadillac-tax-is-halfway-to-repeal-688392

Surviving Surprise Medical Bills

Wednesday, July, 3rd, 2019

Kiplinger’s Personal Finance

https://www.kiplinger.com/article/insurance/T027-C000-S002-surviving-surprise-medical-bills.html?rid=SOC-email#.XVYSlDFaNsM.email

Congress Urged to Rein In Surprise ‘Out-Of-Network’ Medical Bills

Wednesday, June, 12th, 2019

Cox

https://www.wokv.com/blog/jamie-dupree/congress-urged-rein-surprise-out-network-medical-bills/nMIwv8S6u7UWgNiazrlW9L/

No Surprises and Allied Organizations to Congress: It is Past Time to Act On Surprise Billing Protections

Members of No Surprises: People Against Unfair Medical Bills were joined by leading organizations representing patients, consumers, health equity stakeholders, small businesses, children and families in sending the attached letter to Congressional leadership, urging immediate action to provide consumers protection from surprise medical bills.

Surprise billing was a common and destructive problem prior to the pandemic, and the situation is even more dire now. It is well past time to provide consumers relief from this unfair and often devastating practice, particularly as coronavirus infection rates climb and financial insecurity for families remains at record levels.

This letter was signed by –

  • No Surprises Members: American Kidney Fund, American Medical Student Association, Consumer Reports, Families USA Action, Health Access California, Health Care for America Now (HCAN), Indivisible, MomsRising, National Alliance on Mental Illness, National Consumers League, National Partnership for Women & Families, Public Citizen, Voices for Progress, Young Invincibles
  • Supporting Organizations: Asian & Pacific Islander American Health Forum, Association of Asian Pacific Community Health Organizations (AAPCHO), Breast Cancer Action, Center for Medicare Advocacy, Center for Public Representation, Children’s Defense Fund – Texas, Coalition on Human Needs, Every Texan (formerly Center for Public Policy Priorities), First Focus Campaign for Children, Kentucky Voices for Health, Missouri Health Care For All, National Birth Equity Collaborative, National Disability Rights Network, National Health Law Program, National Women’s Health Network, New Jersey Citizen Action, San Francisco AIDS Foundation, Shriver Center on Poverty Law, Small Business Majority, Tennessee Health Care Campaign, U.S. PIRG, WV Citizen Action Group

Read the Letter

No Surprises Letter: Congress Must Act Now to End Surprise Bills

Members of No Surprises: People Against Unfair Medical Bills, representing patients, consumers, and workers, are calling for an overdue end to surprise medical bills in the next pandemic relief legislation.

Unanticipated health care costs, like surprise medical bills, financially devastate families and create a chilling effect on the willingness and ability of families to seek screening and treatment during this pandemic. Additionally, HHS and many experts believe surprise bills are even more likely during the COVID-19 pandemic as families are pushed to out-of-network hospitals for health emergencies or routine care due to hospitals and other providers being overrun with COVID-19 patients. Families can no longer wait, Congress must act now.

The letter has been signed by Families USA Action, American Federation of State, County and Municipal Employees (AFSCME), American Kidney Fund, Americans for Financial Reform, Arthritis Foundation, Community Catalyst, Consumer Reports, Health Access California, Health Care for America Now (HCAN), MomsRising, National Alliance on Mental Illness (NAMI), National Consumers League, National Partnership for Women & Families, Public Citizen, Voices for Progress, and Young Invincibles.

No Surprises Letter: Congress Should Include Surprise Billing Protections in Pandemic Response

Member organizations of No Surprises: People Against Unfair Medical Bills, representing patients, consumers, and workers, sent this letter to policymakers on Capitol Hill, urging them to protect families from further financial uncertainty as they seek health care services by banning surprise out-of-network bills in the next novel coronavirus (COVID-19) response.

Ending surprise bills for consumers is a critical financial protection for families during a time where they are in need of critical health care services and already vulnerable to unexpected costs. During this time, families need unfettered access to health care services. With unprecedented unemployment and economic uncertainty, a surprise bill for seeking medical care could significantly worsen the financial and health tradeoffs families are already facing.

No Surprises Coalition Letter to Committee Leadership

Undersigned members of No Surprises: People Against Unfair Medical Bills sent this letter to committee leaders on Capitol Hill who are negotiating a deal to address surprise medical bills. As the committees come together to negotiate a final bill, we urge them to place the needs of families before health care special interest groups and swiftly act to finalize and advance compromise legislation that finally stops the heinous practice of surprise billing, protects consumers across all health plans and provider settings, and holds health care costs down. Specific recommendations: include a fair, market-based benchmark payment; address air ambulance; insure robust guardrails around any arbitration, and require private equity transparency.

No Surprises Campaign Letter to the Education and Labor and Ways and Means Committees

Members of the No Surprises: People Against Unfair Medical Bills, sent this letter to Capitol Hill in advance of committee consideration of legislation by the Education and Labor and Ways and Means Committees. No Surprises urges members to advance legislation that finally stops the heinous practice of surprise billing, protects consumers across all health plans and provider settings, and holds health care costs down. We believe that a fair, market-based benchmark payment rate, such as is included in the Education and Labor, Energy and Commerce, and HELP proposals, is the most efficient way to settle payment disputes while holding health care costs down for America’s families. We urge Education and Labor and Ways and Means members to work with members on the other committees of jurisdiction to finalize legislation as soon as possible.

Sign-On Letter to Congress: Pass Surprise Billing Legislation by End of Year

Members of the No Surprises Campaign were joined by over 50 allied organizations in signing this letter calling on Congress to pass comprehensive legislation to ban surprise billing by the end of the year. No Surprises campaign members who signed the letter include: Families USA, AFSCME, American Kidney Fund, American Medical Student Association, Arthritis Foundation, Community Catalyst, Consumer Reports, MomsRising, National Consumers League, National Partnership for Women and Families, Public Citizen, and Voices for Progress. Allied organizations who joined the letter include: the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association, and SEIU. Nearly three out of four of voters say they would be concerned if industry lobbying on surprise bills stopped Congress from acting. The time for action is now.

Consumer Groups Letter on Surprise Bills to House of Representatives

Families USA and 17 other consumer groups sent a letter to the House of Representatives urging passage of surprise bill legislation that fully protects consumers while preventing inflation in health care costs. The letter articulates key principles, including that a payment mechanism between insurers and providers should not be based on or factor in providers’ billed charges.

Families USA’s Letter to Capitol Hill on Support for Surprise Billing Legislation

https://familiesusa.org/resources/families-usas-letter-to-capitol-hill-on-support-for-surprise-billing-legislation/

COVID-19, Health System Distortions, and Surprise Medical Bills: Congress Must Act Now

COVID-19, Health System Distortions, and Surprise Medical Bills: Congress Must Act Now

By Natasha Kumar and Jane Sheehan

The growing burden of the COVID-19 pandemic has revealed fundamental cracks in our health care system that we have accepted for far too long. It is well-documented that millions of Americans lack comprehensive health coverage and access to affordable care, and thousands of families in the United States forgo medical care due to cost.[1],[2],[3],[4] A recent nationwide Bankrate survey found that nearly one in three American families have skipped medical care because of cost in the past 12 months alone.[5]

Now we find ourselves eight months into a global health crisis that has caused the biggest financial downturn in generations, and Americans continue to pay far too much for health insurance that often fails them when they need it most. Congress has passed several bills to address the crisis, but it has not included provisions that would ensure comprehensive health insurance or protect patients when their coverage doesn’t pay for necessary care. In fact, Congress is currently sitting on bipartisan solutions that would address egregious health system flaws such as surprise medical billing, leaving more families at risk every day that passes without action.

At a time when the pandemic has caused widespread economic devastation, Congress should make it a top priority to pass legislation that protects constituents in every district while lowering health care spending.

Many Americans Have Received Unexpected Medical Bills for COVID-19 Treatment

Since the onset of the COVID-19 pandemic, people across the country have come forward with stories of being charged ludicrous amounts for basic medical care despite the fact that they are insured and seek care from providers who are in-network.

Stories like that of Osmel from Miami, who sought care for flu-like symptoms and was slapped with a bill of $3,270 – more than twice what the hospital told him he would owe[6] – are far too common.

Timothy from Colorado experienced COVID-19 symptoms and went to his local emergency department (ED), where he received a chest X-ray, an electrocardiogram, and was prescribed an inhaler. He was billed $3,278, and his insurer covered only about a third of the bill, despite the fact that he verified in advance that the ED was in his network.[7]

And there are stories like that of Andrew from Vermont, who sought medical attention from his physician after experiencing fever, malaise and difficulty breathing. After testing negative for the flu and other viruses, he received a call from an infectious disease department asking him to report to the ED for a COVID-19 test. He had already met his deductible and assumed his care would be covered. Instead, he found out that the ED physician who saw him was staffed from an out-of-network provider service, leaving him with surprise medical bills totaling close to $2,000. [8]

These stories are not isolated events. A Kaiser Family Foundation analysis found that COVID-19 patients with complications or other illnesses can face treatment costs of over $20,000. They also found that out-of-pocket costs for all patients admitted for COVID-19 treatment, regardless of their health status, would regularly exceed $1,300.[9]

Prior to the COVID-19 pandemic, surprise medical bills plagued consumers for decades. Recent studies estimated that nearly one in five ED visits resulted in out-of-network charges, and more than one in five claims for lab services provided at in-network hospitals were billed as out-of-network.[10], [11]

Now, it is likely that consumers will be hit even harder by surprise bills as families are pushed to out-of-network facilities for health emergencies or routine care because hospitals and other providers are being overwhelmed by COVID-19 patients.[12] And this comes in the context of an economy where a staggering 120 million adults, or 48% of all U.S. residents over the age of 18, have lost employment income since mid-March and simply cannot afford a surprise medical bill.[13]

Congress Must Act to Protect Patients from Surprise Medical Bills

So, what can Congress do to address this problem? In 2019, Congress examined surprise billing practices, which resulted in a bipartisan, bicameral legislative solution known as the Lower Health Care Costs Act.[14] This proposal would provide comprehensive consumer protections; improved transparency around health care quality and costs; and a fair, market-based reimbursement methodology. By addressing some of the most damaging flaws in our health care system, the Lower Health Care Costs Act would help reduce health care costs and improve health care quality for all. Yet, despite bipartisan support and the expressed interest of the Trump administration, lawmakers were unable to pass comprehensive protections before the onset of the COVID-19 pandemic.

This May, in the absence of legislation to curb this practice altogether, the federal government took limited steps to prevent specific instances of surprise billing related to COVID-19. Federal guidelines that were contained in the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act require insurers to cover the cost of appointments (including cost-sharing) when providers order or administer COVID-19 tests.[15] Additional HHS guidance states that patients who are considered “at risk” for COVID-19 should be safe from surprise medical bills. However, there is still no consensus on how this guidance would be enforced, and these protections would apply only to patients who seek care from health care facilities that have received financial support through the recently enacted Provider Relief Fund. [16], [17]

Unfortunately, this leaves gaping holes that keep patients on the hook for extremely high bills. HHS agrees that a federal legislative solution is needed to permanently protect consumers.[18] If patients seek care for COVID-19-related symptoms and do not receive a COVID-19 test, they could face unexpected bills. This fact, coupled with the national shortage of COVID-19 tests, [19] shows that current measures are nowhere near enough to protect patients from high bills. Furthermore, none of these measures does anything to help people who seek medical care for situations unrelated to COVID-19, such as car accidents, cancer treatments or childbirth.

Conclusion

To respond to the pandemic and the widespread economic devastation it has caused, Congress should prioritize passing legislation that protects constituents in every district while lowering health care spending. The next coronavirus stimulus package presents an opportunity for ending this nightmare for thousands upon thousands of patients across the country. With the White House on board[20], [21] and a bipartisan deal in hand, Congress has all the pieces in place to finally pass a legislative solution that will end this practice during the pandemic and beyond.[22]

Endnotes

[1] Lydia Saad, “More Americans Delaying Medical Treatment Due to Cost,” Gallup, December 9, 2019, https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx.

[2] Bruce Japsen, “Poll: 44% of Americans Skip Doctor Visits because of Cost,” Forbes, March 26, 2018, https://www.forbes.com/sites/brucejapsen/2018/03/26/poll-44-of-americans-skip-doctor-visits-due-to-cost/ – 55d9b3e26f57.

[3] Shawn M. Carter, “Over Half of Americans Delay or Don’t Get Health Care because They Can’t Afford It—These 3 Treatments Get Put Off Most,” CNBC, November 29, 2018, https://www.cnbc.com/2018/11/29/over-half-of-americans-delay-health-care-becasue-they-cant-afford-it.html.

[4] Elisabeth Rosenthal, “How the High Cost of Medical Care Is Affecting Americans,” The New York Times, December 18, 2014, https://www.nytimes.com/interactive/2014/12/18/health/cost-of-health-care-poll.html.

[5] Sarah Foster, “Survey: As Coronavirus Spreads, Nearly 1 in 3 Americans Admit to Not Seeking Medical Care Due to Cost,” Bankrate, March 12, 2020, https://www.bankrate.com/surveys/health-care-costs/.

[6] Ben Conarck, “A Miami Man Who Flew to China Worried He Might Have Coronavirus. He May Owe Thousands,” Miami Herald, February 24, 2020, https://www.miamiherald.com/news/health-care/article240476806.html?mod=article_inline.

[7] Phil Galewitz, “COVID-Like Cough Sent Him to ER—Where He Got a $3,278 Bill,” Kaiser Health News, May 25, 2020, https://khn.org/news/covid-like-cough-covid19-symptoms-emergency-room-billing-code-surprise-medical-bill/.

[8] Emmarie Huetteman and Elisabeth Rosenthal, “He Got Tested for Coronavirus. Then Came the Flood of Medical Bills,” The New York Times, March 30, 2020, https://www.nytimes.com/2020/03/30/opinion/coronavirus-test-cost-bill.html?auth=login-email&login=email.

[9] Gary Claxton, Cynthia Cox, Nisha Kurani, Daniel McDermott, and Matthew Rae, “Potential Costs of COVID-19 Treatment for People with Employer Coverage,” Peterson-KFF Health System Tracker, March 13, 2020, https://www.healthsystemtracker.org/brief/potential-costs-of-coronavirus-treatment-for-people-with-employer-coverage/.

[10] Elena Renkin, “Study: 1 In 5 Patients Gets A Surprise Medical Bill After Surgery,” National Public Radio, February 11, 2020, https://www.npr.org/sections/health-shots/2020/02/11/804906330/study-1-in-5-patients-gets-a-surprise-medical-bill-after-surgery.

[11] Kevin Kennedy, Bill Johnson, and Jean Fuglesten Biniek, “Surprise Out-of-Network Medical Bills during In-Network Hospital Admissions Varied by State and Medical Specialty, 2016,” Health Care Cost Institute, March 28, 2019, https://www.healthcostinstitute.org/blog/entry/oon-physician-bills-at-in-network-hospitals.

[12] Elizabeth Rosenthal and Emmarie Huetteman, “Analysis: He Got Tested for Coronavirus. Then Came the Flood of Medical Bills,” Kaiser Health News, April 1, 2020, https://khn.org/news/covid19- coronavirus-test-surprise-medical-bill/.

[13] U.S. Census Bureau, “Employment Table 1. Experienced and Expected Loss of Employment Income, by Select Characteristics: United States,” Household Pulse Survey: May 14–19, 2020, May 27, 2020, https://www.census.gov/data/tables/2020/demo/hhp/hhp3.html.

[14] U.S. Congress, Senate. Committee on Health, Education, Labor and Pensions, Lower Health Care Costs Act bill summary, 116th Cong., 2nd session, 2019, https://www.help.senate.gov/imo/media/doc/LHCC%20Section-by-Section_FINAL.pdf.

[15] Centers for Medicaid and Medicare Services, “FAQs about Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation Part 42,” Centers for Medicare and Medicaid Services, April 11, 2020, https://www.cms.gov/files/document/FFCRA-Part-42-FAQs.pdf.

[16]  Carmen Heredia Rodriguez, “COVID-19 Tests That Are Supposed to Be Free Can Ring Up Surprising Charges,” National Public Radio, April 29, 2020, https://www.npr.org/sections/health-shots/2020/04/29/847450671/covid-19-tests-that-are-supposed-to-be-free-can-ring-up-surprising-charges.

[17] Emmarie Huetteman, “In Fine Print, HHS Appears to Ban All Surprise Billing During the Pandemic,” Kaiser Health News, April 17, 2020, https://khn.org/news/in-fine-print-hhs-appears-to-ban-all-surprise-billing-during-the-pandemic/.

[18] Office of the Assistant Secretary for Planning and Evaluation, “HHS Secretary’s Report on: Addressing Surprise Medical Billing,” U.S. Department of Health & Human Services, July 29, 2020, https://aspe.hhs.gov/system/files/pdf/263871/ASPE_Surprise_Billing_Report%20_2020.07.29.pdf.

[19] Manny Fernandez and Sarah Mervosh, “Months into Virus Crisis, US Cities Still Lack Testing Capacity,” The New York Times, July 15, 2020, https://www.nytimes.com/2020/07/06/us/coronavirus-test-shortage.html.

[20] Susannah Luthi and Rachel Roubein, “White House Bids for ‘Surprise’ Billing Fix ahead of Next Rescue Package,” Politico, May 27, 2020, https://www.politico.com/news/2020/05/27/white-house-surprise-billing-healthcare-coronavirus-rescue-285780.

[21]Office of the Assistant Secretary for Planning and Evaluation, “HHS Secretary’s Report on: Addressing Surprise Medical Billing,” U.S. Department of Health & Human Services, July 29, 2020, https://aspe.hhs.gov/system/files/pdf/263871/ASPE_Surprise_Billing_Report%20_2020.07.29.pdf.

 

Setting the Record Straight on Surprise Medical Bills

Claudia Knafo, a Families USA storyteller from New York City, submitted this letter to the editor of the New York Post in response to a May 9 article, “Lawmaker Wants to Limit Insurance Reimbursements to Healthcare Workers.” In the letter, Claudia details her harrowing experience after receiving a surprise medical bill. To read more about Claudia’s story, check out this interview she did last year about surprise medical bills with ABC News’ Start Here podcast.

Mr. Stephen Lynch
Editor-in-Chief
New York Post
1211 Avenue of the Americas
New York City, NY 10036

May 20, 2020

Dear Mr. Lynch:

Isabel Vincent’s May 9 article, “Lawmaker Wants to Limit Insurance Reimbursements to Healthcare Workers,” only offers one side of the surprise medical bill debate, that of health industry special interests, not my side of the story as a New Yorker and the story of thousands of families across the nation who have been financially devastated by surprise medical bills.

For me, the surprise medical bill came as the result of critical spine surgery on April 12, 2012, that I needed to decompress my cervical spine. I had worked diligently with the doctor’s office manager, my insurance company, and the hospital’s patient services to make sure everything would be covered as in-network care. After receiving the surgery, however, the insurance company changed course, and, in the end, I was stuck with a bill for $101,000; it was financially devastating. As a result, I have had to write to the New York Department of Financial Services, I had to write to the attorney general of New York, and I consulted with a patient advocate attorney, all in the name of fighting for justice and getting us out of financial bankruptcy.

And it is important to say that surprise bills continue, even during this worldwide pandemic. A few weeks ago, as I was quarantining in my home, I was called from an out-of-network doctor’s office to schedule a procedure. During the call, the doctor joined the call, got on the phone unsolicited. A few days later, I received a bill for $150 for “an out-of-network” phone call. Understand this was not a telemedicine visit; I was simply working with the office to schedule a procedure. And, now, during the pandemic, I have to fight yet another surprise medical bill.

The bipartisan legislation described in the article by Ms. Vincent places the needs of families like mine before health care special interest groups, and would finally stop the devastating practice of surprise billing. The article unfairly described the legislation as creating “price controls.” That’s completely wrong. Experts have testified that this legislation uses a fair, market-based approach to settle claims promptly for the benefit of providers and insurers alike. Most importantly, the legislation would take families out of the middle of these fights between insurers and hospitals, and provide a level of certainty, which in times like these is sorely needed.

And certainty around medical bills is needed now more than ever. Surprise medical bills have been an ongoing problem for consumers, but the threat is more significant due to COVID-19 as families are pushed to out-of-network care as in-network providers are swamped with COVID-19 cases and as hospitals contract with additional providers that are out-of-network to fill in the gaps. Nowhere in the nation is this more of a concern than in New York and for your readers given the devastating impact of COVID-19 in the New York community.

COVID-19 is both a health and economic crisis. Establishing broad protections against all surprise medical bills will help ensure families can get the full spectrum of care they need and protect families’ financial security. These protections are about protecting families, not politics.

I hope Ms. Vincent will see this letter and consider hearing another side — that of the families trying to survive a pandemic and who stand to lose their health, homes, and livelihoods if Congress does not take immediate action to end surprise medical bills.

Sincerely,

Claudia Knafo
New York City

The Threat of Surprise Medical Bills during COVID-19 Is Even Greater, and New Administrative Protections Haven’t Solved the Problem

Now more than ever, families are vulnerable to unexpected health care costs due to both the spread of COVID-19 and rising unemployment rates. Americans should not have to fear or manage the financial impact of receiving a surprise medical bill for putting the health of themselves, their family members, and all in our nation first. Moreover, according to a recent poll, one out of every seven U.S. adults report that they would avoid seeking care for COVID-19 because of concerns about the cost of care. When the sick avoid seeking care, the outbreak is prolonged, and everyone’s health is at greater risk.

The Administration has taken recent actions to discourage surprise billing during the pandemic, but these safeguards are not comprehensive. They do not apply to all providers or all patients. These safeguards also are not statutory or
regulatory, meaning families who try to challenge surprise medical bills could face extensive litigation. Comprehensive surprise medical bill protections are still needed.

Surprise Billing Protections Belong in Congress’ Next COVID-19 Relief Package

As our nation confronts a public health and economic threat greater than any we’ve seen in a century, every family is struggling to understand and manage the devastating and far-ranging effects of COVID-19. During this crisis, families need unfettered access to health care services. And, with unemployment higher than it’s been in decades and widespread economic uncertainty, we also must ensure the financial security of America’s families as they seek and receive medical care.

Unanticipated health care costs, like surprise medical bills, not only financially devastate families but also create a terrible chilling effect on the willingness and ability of families to seek screening and treatment during this pandemic. Moreover, as Congress and the federal government provide hundreds of billions of dollars to hospitals, doctors, and other medical providers to support their financial security, it is critical that these same providers safeguard the physical and financial health of the families they are treating by eliminating all surprise medical bills.

Comparing Federal Surprise Medical Bill Proposals: How Do Consumers and Families Fare in the Current Debate?

Principle 1: Protect Patients In All Care Settings

All of the proposals ban surprise bills in hospitals, clinics, and doctors’ offices, where most surprise bills occur. Two out of four bills — those passed by the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Education and Labor (E&L) Committee — ban surprise bills by air ambulance companies. Disappointingly, none of the bills bans surprise billing by ground ambulances.

Principle 2: Do Not Increase Health Care Costs Across The System

The Senate HELP, House Energy and Commerce (E&C), and House E&L committees’ legislation all save at least $24 billion in federal spending. The House Ways and Means (W&M) Committee’s proposal still saves a significant amount — $18 billion — but its savings is roughly one-quarter less than that of the other committees due to a meaningful difference in how it manages payment disputes between plans and providers (more on that below).

Principle 3: Apply To All Private Insurance Plans

All of the bills meet this principle, applying patient protections to all private insurance plans. (Medicare and Medicaid already prohibit surprise billing.)

Over the past several months, all four committees with jurisdiction over aspects of surprise medical bills have marked up their own versions of legislation to ban surprise bills. Lawmakers and stakeholders alike have worked to understand the differences between the pieces of legislation and to assess which of the proposals are best for consumers. The chart below provides a quick thumbnail sketch of the primary differences between these bills.

Comparison of CBO-Scored Surprise Billing Legislation

The Congressional Budget Office has completed analysis of four committee-passed policy proposals related to surprise medical bills. This fact sheet describes each of the proposals and its CBO score. Proposals that rely more heavily on arbitration to determine out-of-network provider payments are shown to save less due to the effect of higher premiums, reduced wages, and administrative costs. Click the link below to view the fact sheet.

 

 

Testimony on Surprise Billing Before the House Energy and Commerce Subcommittee on Health

https://familiesusa.org/resources/testimony-on-surprise-billing-before-the-house-energy-and-commerce-subcommittee-on-health/