Surprise Billing

What’s new?

  • On May 16, Senators Cassidy (R-LA), Bennet (D-CO), Young (R-IN), Hassan (D-NH), Murkowski (R-AK) and Carper (D-DE) introduced transparency legislation, “Stopping the Outrageous Practice (STOP) of Surprise Bills Act of 2019.
  • On May 14, 2019 House Energy and Commerce Committee Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) introduced a bipartisan discussion draft, the No Surprises Act (see External Resources below).
  • On May 9, 2019 President Trump and Health and Human Services Secretary Alex Azar announced principles to increase transparency and end surprise billing as part of an initiative to lower healthcare costs in the United States.
  • The House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions on April 2, 2019 held a hearing titled “Examining Surprising Billing: Protecting Patients from Financial Pain.”
  • On February 20, 2019 The American Hospital Association and The Catholic Health Association along with other provider associations authored a letter committing to Congress that all providers are committed to protecting patients from “surprise bills”.

What is the issue?

  • Reports of patients receiving unexpected, large healthcare bills as a result of hospital stays has generated concern from lawmakers.
  • AARP estimates that one in seven patients will receive a “surprise bill” as a result of a hospital stay.
  • Health insurance and health care billing are complex, and it can be difficult for patients to understand their coverage and obligations.
  • A surprise bill may occur when a patient receives care from an out of network provider or when their health plan fails to pay for covered services. The three most typical scenarios are when:
    • A patient accesses emergency services outside of their insurance network, including from providers while they are away from home
    • A patient receives care from an out of network physician providing services in an in network hospital
    • A health plan denies coverage for emergency services saying they were unnecessary

Why does it matter?

  • Although insurers are in the best position to help patients understand what is considered in network or out of network, everyone providing health care services has a role to play in helping consumers navigate the complicated health care delivery system.
  • Patients should have certainty regarding their cost-sharing obligations, which should be based on an in-network amount.
  • Patients should be assured of access and coverage for emergency care.
  • Patients should not be used as the crosswalk between insurers and healthcare providers. Surprise bills are a direct result of a lack of negotiated contract between the patient’s insurer and the hospital and/or physicians that provided their care.

What is the AMITA Health perspective?

  • AMITA Health believes that all patients, regardless of ability to pay, have a right to high quality, efficient healthcare. Patients through their insurance provider should have access to a comprehensive network of providers, including in-network physicians and specialists at in-network facilities.
  • Families should be protected from financial burdens of unexpected medical bills. Surprise bills are a direct result of a lack of negotiated contracts between insurers and providers.  Patients should be taken out of the middle of standard negotiations when they have not had the opportunity to choose who provides their care.

External Resources

Information from third-party organizations that can be resources for you to continue to learn about the issues at hand.

Stop Surprise Medical Bills Summary

Summary of bipartisan draft legislation to address surprise medical bills in the U.S. Senate entitled Stop Surprise Medical Bills

View Resource

No Surprises Act Discussion Draft

Bipartisan discussion draft of legislation to address surprise billing in the U.S. House of Representatives entitled the No Surprises Act.

View Resource

Featured News

Featured news includes articles and tweets from multiple viewpoints and is designed to keep you abreast of the current debate around issues that are important to AMITA Health. This information should not be construed as our point of view.

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Surprise Billing Comparison: What You Need to Know

The question is not if, but how: How will lawmakers tackle surprise billing? What started out as question for a small Senate working group in ...

National Law Review + May 20, 2019 + View Article

America’s Health Insurance Plans Issues Statement on No Surprises Act

America’s Health Insurance Plans issued the following statement by President and CEO Matt Eyles after the introduction of the No Surprises Act by House Energy ...

Insurance News Net + May 15, 2019 + View Article