Policy Analyst on How the COVID Relief Bill Will Address Surprise Medical Billing

Posted: Dec 25, 2020 3:15 PM
Policy Analyst on How the COVID Relief Bill Will Address Surprise Medical Billing

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A Philadelphia woman struggling with COVID was unconscious when doctors decided to airlift her to a hospital with better resources. She stayed at the hospital for six weeks before her recovery. She couldn't enjoy her improved health for long though, as she soon received in the mail a surprise bill for $52,112 for the helicopter ride. 

Her plight, while perhaps more dramatic than most, is shared by millions of Americans every year. Every day patients receive surprise bills for medical care they didn't know was out-of-network. Reports suggest that 1 in every 5 trips to the ER end in a surprise bill. 

Josh Archambault, a senior fellow at the Foundation for Government Accountability, puts the number at about 20 percent of people receiving emergency care gets some surprise bill. 

Not only do those surprise costs cause immediate distress, he explained. But if the bill ends up in collections and affects one's credit, the economic effect is "pretty significant," as it can prevent that individual from getting approved for a loan.

But a proposal in the second COVID relief package would give patients an "advanced explanation of benefits" with an estimated cost of care.

There are two key pieces to the proposal, Archambault explains. It would end the practice of surprise billing, with the only exception of on the ground ambulances. 

"For the vast majority of cases, this should protect the patient, and find a resolution for it," he said. 

Secondly, on broader price transparency provision, patients will have "a greater awareness" of what things cost ahead of time. 

The Journal Times provides a few more specifics:

  • Hold patients harmless from surprise bills stemming from emergency medical care. That would apply if the patient is seen at an out-of-network facility, or if they are treated by an out-of-network clinician at an in-network hospital. In either case, the patient could only be billed based on their plan's in-network rate.
  • Protect patients admitted to an in-network hospital for a planned procedure when an out-of-network clinician gets involved. This can happen when a surgeon is called in to assist in the operating room, or if the anesthesiologist on duty is not part of the patient's plan.
  • Generally require out-of-network service providers to give patients 72-hour notice of their estimated charges. Patients would have to agree to receive out-of-network care for the hospital or doctor to then bill them.
  • Bar air ambulance services from sending patients surprise bills for more than the in-network cost sharing amount. Air ambulance charges have become a bigger problem in states where patients have to travel long distances to get to the best hospitals. However, ground ambulance services will not face the same restrictions, and the legislation only calls for more study of their billing practices.

While the COVID relief measure passed both chambers this week, President Trump kicked it back to Congress to ask lawmakers to increase the stimulus money for Americans. Should it not be signed, Archambault hopes Congress doesn't give up on the pressing issue.

"I just hope that Congress doesn't wash their hands of this issue," Archambault said.

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