Americans have been through a lot this year. They’re worried about their health, the economy and whether they can provide for their families. Congress can take one of these worries off of their plate by eliminating the risk that they’ll receive a surprise medical bill.
Too many patients receive a surprise medical bill after seeing a health care provider they were not able to choose: maybe they needed emergency care at an out-of-network hospital, or maybe they were treated by an out-of-network doctor even though they chose an in-network hospital.
In 2018, Todd, a father from Knoxville, took his son to the emergency room after a bicycle accident. His son was treated, Todd paid a $150 copay because the emergency room was “in-network” for his health insurance, and they headed home. So Todd’s family was shocked after receiving a bill for $1,800 — because even though the emergency room was “in-network,” the doctor who treated his son was not.
Judith from Louisiana tells the story of her brother, whose standard bloodwork was performed unknowingly by an out-of-network lab, even after he had tried to make sure it was sent to an in-network lab. Afterward, he was sent a bill for $1,200 that he could not afford to pay, and as a result, his credit rating has taken a severe hit.
Before the COVID-19 pandemic, one out of five patients who went to an emergency room received a surprise medical bill weeks later. It’s time for Congress to make sure that patients don’t receive a surprise medical bill when they seek medical treatment, especially during this crisis, and permanently after the crisis is over.
Though the Administration and Congress have taken steps to protect patients receiving COVID-19 testing and treatment from surprise bills, gaps remain.
According to the New York Times, one patient got charged $2,718 for a single COVID-19 diagnostic test. These tests typically cost around $100.
And for care or testing unrelated to COVID-19, most Americans have no protection from surprise bills.
Clearly, congressional action is needed to end the practice of surprise medical billing across the board.
Fortunately, there is a solution that is supported by large bipartisan majorities in three congressional committees: the Senate Committee on Health, Education, Labor and Pensions; the House Committee on Energy and Commerce; and the House Committee on Education and Labor. This solution has been improved by the efforts and hard work of the 30 Senate sponsors of the STOP Surprise Medical Billing Act.
First, get patients out of the middle of billing disputes — no questions asked. Second, provide timely payment to health care providers based on where the patient lives and where they receive care. This is often called an interim payment. Third, if a health care provider determines the interim payment is unfair, the payment can be changed through a process known as Independent Dispute Resolution, more commonly referred to as baseball-style arbitration.
Reaching this solution wasn’t easy — it has taken two years and a lot of compromise by Democratic and Republican members of Congress and stakeholders who are all pushing to end surprise billing. But this is a reasonable solution to an intractable problem and has broad bipartisan support in Congress, and the president has indicated his willingness to sign this legislation into law.
Patients should be the reason for the care, not an excuse for the bill. It’s time to put an end to the practice of surprise medical bills that are not limited by anything but a sense of shame.
It’s time for Congress to act.
Lamar Alexander is a Republican representing Tennessee in the U.S. Senate. Bill Cassidy is a Republican representing Louisiana in the U.S. Senate.