AHIP, Employer Groups Seek Congressional Action on Surprise Medical Bills

America’s Health Insurance Plans (AHIP) and 16 other organizations sent recommendations to Congress this week that they said will protect Americans from surprise medical bills.

Besides AHIP, the signers included the National Business Group on Health, the National Retail Federation, the Pacific Business Group on Health, the National Alliance of Healthcare Purchaser Coalitions, the National Association of Health Underwriters, and others. The letter said that 1 in 5 people receive unexpected medical bills every year and asked “that Congress take action this year to pass legislation that will protect patients from surprise medical bills and reign in out-of-control healthcare costs.”

The requested actions include:

• Prohibiting doctors from sending a surprise medical bill to patients in cases of emergency, involuntary care, or instances where the patient had no choice in their provider.
• Requiring facilities to inform patients of their doctors’ network status and possible options for seeking care from a different doctor, but not requiring patients to consent to out-of-network care.
• Avoiding the use of difficult-to-understand arbitration processes that can lead to higher premiums.
• Setting reimbursement rates that will not increase premiums or affect access for consumers by basing amounts on market rates determined by reasonable, contracted amounts paid by health insurance providers to similar doctors in a geographic area or a percentage of Medicare.
• Ensuring that these protections apply to all health plans, including self-funded plans governed by the federal Employee Retirement Income Security Act of 1974, or ERISA. ERISA does not prohibit balance billing, even as more states move to protect consumers against surprise medical bills.

The issue ranks high among the public; a September poll from the Kaiser Family Foundation found that unexpected medical bills worried 67% of Americans and that 4 out of 10 had received such a bill in the past year.

A number of legislative bills have been introduced to limit consumer exposure to out-of-network bills. Senator Maggie Hassan and Senator Jeanne Shaheen, both Democrats from New Hampshire, introduced 2 such measures last fall.

In addition, a bipartisan group of senators, led by Senators Bill Cassidy, MD, R-Louisiana, and Michael Bennet, D-Colorado, introduced a bill last year.