Tuesday, June 25, 2019
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Congress Plans to Stop Surprise Medical Bills, But Faces One Big Question

President Trump has pledged to sign a bill that will block surprise medical bills.

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President Trump and Democrats want to get rid of one of the most important health care problems in the United States; however, lawmakers have one big problem to solve before they start implementing the bill.

Suddenly, Congress is having a number of bills to stop surprise medical bills, which can leave some insured people with thousands of dollars in medical bills just for a simple trip to the ER, but how much medical providers get and by what means is a big question.

On Thursday, two top Republican and Democrats on the Senate health committee, Sen. Lamar Alexander and Sen. Patty Murray, introduced a health care costs bill, which did not come up with a way for out-of-network medical providers to get paid by insurers. Rather, the bill offers three options for determining those payments, which will be decided later which one to include in the final version.

One of the biggest issues to figure out for any bill to prevent surprise medical bills is the provider payments. It affects doctors, hospitals, and insurers. Senate Bills and Different House would establish different systems for how provider payments would be determined.

Nevertheless, solving this issue is a big hurdle to doing something.

The Representative for Oregon and the member of the Republican Party Greg Walden said, “My No. 1 goal is clear: Let’s protect patients by ending surprise medical bills. The path to achieving this goal has multiple roads. I believe it’s fair to base the compensation mechanism off of private-market rates and that any solution should not raise federal health care costs. This is one solution. Arbitration is another.”

Congress is quite serious about doing something on surprise medical bills.

Under the proposed legislation, if someone visits the ED or get surgery, and the facility of their provider is not in their insurer’s network, they cannot be asked to pay the full cost for the care they received. This practice is known as balance billing. When a medical provider bills you, the balance between what your insurer paid for a service and the price the provider wants to charge for service is prohibited.

The Alexander-Murray legislation dictates, “Patients cannot be charged extra money for any emergency care, ancillary care (anesthesia, radiology, etc.), or diagnostic care they receive from an out-of-network provider. They can only be billed for whatever co-pays, co-insurance or other cost-sharing they would have been required to pay for an in-network provider under their health insurance plan.”

And if someone is shifted from the ER to a general hospital setting, they must be informed in advance about any out-of-network service and its costs. Also, they must be informed of the in-network options that are available to them.

Physicians and insurers really prefer some sort of arbitration. They want the opportunity to appeal and seek a better price for their care.

Surprise medical bills with exorbitantly high and irrational prices are only a symptom of the underlying disease that has been affecting American health care. Even patients who have insurance are affected by the medical bills that are way too high. States like New York and California are acting on their own to clamp down on surprise medical bills; however, Congress has been insistent on taking any action nationwide.

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