Not enough attention has been given to the new law curbing surprise medical bills and balance billing; the measure is worth celebrating, but Congress failed to address the most prevalent source of unexpected health care bills.
After years of failed attempts, lawmakers finally reached a deal to end big unexpected medical bills for people who have private insurance. The measure was passed as part of the big package that included coronavirus relief.
Charges can run up to tens of thousands of dollars from health care providers that are outside the network of a patient's health insurance plan. It's estimated that 1 in 5 emergency room visits and 1 in 6 inpatient admissions trigger a surprise bill.
“This has been a profoundly distressing pocketbook issue for families for years,” said Karen Pollitz, a health insurance expert with the nonpartisan Kaiser Family Foundation, in a recent story from The Associated Press. “Some of these bills are onerous, and they all strike people as completely unfair.”
Out-of-network medical providers demand patients pay amounts their insurer did not cover in a practice known as balance billing. The amounts can be ruinous.
Lawmakers have fought for years to end the practice, but some doctors, hospitals and insurers have long lobbied to protect their own bottom lines. The result had been inaction until now. The new law will protect patients and their families from financial ruin by limiting what they can be billed for out-of-network services to a fee based on in-network charges. The amount consumers pay will count toward their in-network deductible. Health care providers will submit their billing disputes to an independent dispute resolution process under prescribed guidelines. The main provisions of the legislation, however, will not take effect until Jan. 1, 2022.
But one lobbying group managed to strip their billing out of the final deal: ground ambulance providers. Air ambulances are included, but ground ambulance services, both for profit and nonprofit, are excluded given — in addition to industry lobbying — the lack of clear information from providers on the actual costs involved for the various small local, state and regional providers as well as the tangle of jurisdictions involved. Instead, the law calls for an advisory committee to recommend how to regulate these providers’ billing practices.
But ambulances have the highest out-of-network billing rate of any medical specialty. To make it worse, in many jurisdictions — including Joplin — there is only one ground ambulance provider, leaving consumers without options. Many rides can and do result in a surprise bill, and some ground ambulance services are notoriously reluctant to commit to billing agreements with insurers.
Despite the difficulties, it makes little sense to address surprise billing yet exclude the biggest source of those bills. Lawmakers must immediately constitute this committee, require its report to be submitted quickly and then act to protect consumers.
Until the ground ambulance providers are included, patients will continue to open their mail to a big shock.