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Adrian Daily Telegram: House subcommittee holds hearing on surprise medical bills

April 5, 2019
Tim In The News


WASHINGTON According to a news release from the office of U.S. Rep. Tim Walberg, R-Tipton, who serves as the subcommittee’s ranking member, the issue is among the leading health care concerns for Americans.

“The high and rising cost of health care is a significant worry for families, workers, and employers across the country. Concerns about high premiums, high deductibles, and drug prices are known and well-documented, but the issue of surprise billing has rapidly risen to the forefront of peoples’ worries when it comes to health care,” Walberg said in the release.

The release cited concerns about the financial stress placed on workers and families, many of whom don’t set aside funds for unforeseen medical expenses, resulting from unexpected medical bills, stating that patients deserve access to clear and comprehensive information about their health care coverage to avert unexpected bills.

“Surprise billing, sometimes called balance billing, happens when a patient visits an out-of-network care facility, or even when they are at an in-network facility but are seen by a doctor who is not in their network,” Walberg said. “The story of surprise billing may go something like this: A worker who’s having trouble breathing visits an emergency room at a hospital in his health insurance network. While there, he receives an X-ray of his chest and is seen by a doctor who prescribes medicine to ease the strain on his lungs. Following the visit, he gets a bill — a high bill — for the trip to the emergency room. Even though the hospital was technically in-network, the doctor who saw him was not, leaving him to pay for the cost of the treatment.”

To remedy surprise billing, according to Walberg, federal solutions should expand the Employee Retirement Income Security Act (ERISA) coverage, which covers 110 million people through employer-sponsored insurance plans. The release states that this would remedy the situation while expanding patient choice and safeguard employer-sponsored health coverage.

The problem goes beyond unexpected bills. The National Association of Health Underwriters commended the subcommittee for having its first hearing of the 116th Congress on this topic. NAHU CEO Janet Trautwein said in a news release its more than 100,000 licensed agents and brokers “help secure health insurance for their clients but also help manage many day-to-day activities, including resolving claims disputes and billing problems.”

“To that end, NAHU has compiled a number of surprise-billing stories from across the country,” Trautwein said.

“It is not uncommon for agents to spend many months working to resolve billing issues,” she said. “Our agents have found offers to negotiate to 125% of Medicare are routinely refused. The time expended on these negotiations between the carrier and the provider can be lengthy for even amounts as small as $300. One agent reported that 66 touches with the billing office were made on one issue. Some claims have required as many as 115 or more contacts over several months. On the bright side, one agency reported some success in negotiating down the bills, saving consumers over $2.1 million in 2018 alone.”

Trautwein suggested in a situation like that outlined by Walberg of a patient visiting an in-network emergency department but being treated by an out-of-network doctor, that the patient be billed the in-network price.

“That would keep premiums low and give providers an incentive to join more networks — both of which benefit patients,” she said.

This article originally appeared in the April 5 edition of the Adrian Daily Telegram.