Surprise Billing

What’s new?

  • On July 29, 2020 the HHS office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report on addressing surprise billing in response to a requirement in Executive Order 13877 “Improving Price and Quality Transparency in American Healthcare to Put Patients First”. The report explains why federal legislation is needed to address surprise billing.

What is the issue?

  • Surprise billing is a widespread and costly problem in the U.S. A person may receive a large bill for medical services received in an emergency situation, where there is no realistic opportunity to select providers. Or a person may receive a bill for medical care received at an in-network facility that is provided by an out-of-network provider, without being forewarned that this is occurring.
  • In these situations, patients are not able to engage in informed decision-making and lack basic consumer protections, such as transparent pricing, which would normally protect them from receiving excessively high bills.
  • Reports of patients receiving unexpected, large healthcare bills as a result of hospital stays has generated concern from lawmakers.

Why does it matter?

  • Health insurance and health care billing are complex, and it can be difficult for patients to understand their coverage and obligations.
  • AARP estimates that one in seven patients will receive a “surprise bill” as a result of a hospital stay.
  • Patients should have certainty regarding their cost-sharing obligations and should be assured of access and coverage for emergency care.
  • The COVID-19 pandemic underscores the urgency of addressing the issue and illustrates that action on surprise billing is possible.
  • There is bipartisan support that patients should not be subject to surprise medical bills and congressional leaders have expressed that they are committed to addressing this problem.

What is the AMITA Health perspective?

  • AMITA Health believes that all patients, regardless of ability to pay, have a right to high quality, efficient, affordable healthcare. Patients should not be used as the crosswalk between insurers and healthcare providers. 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.
  • 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.
  • A mandated government rate is not the solution. Setting a government-mandated rate, which would become a default rate for non-contracted services, could threaten already limited hospital resources and create a disincentive for health plans to establish adequate coverage networks. This could disproportionately harm patients and hospitals in rural and underserved communities.

External Resources

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

IHA Surprise Billing Issue Brief

Illinois Health and Hospital Association issue brief on surprise billing.

View Resource

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.

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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 Medical Bill Legislation Takes A Step Forward, But Will It Lead To A Step Back?

The House Energy and Commerce Committee Wednesday approved its version of legislation to curb surprise medical bills.

Kaiser Health News + July 17, 2019 + View Article

CBO: Senate surprise billing legislation would save feds $7B over next decade

Major Senate legislation to tackle surprise medical bills and high drug prices would save the federal government roughly $7 billion over the next decade, according to ...

Fierce Healthcare + July 16, 2019 + View Article