U.S. Sens. Bill Cassidy (R-LA) and Todd Young
(R-IN) are among a bipartisan group of senators who released a discussion draft for the Protecting Patients from Surprise Medical Bills Act.
“Surprise medical billing occurs when a patient receives an unexpected medical bill from a doctor that is unknowingly out-of-network,” explained Sen. Young in a Sept. 18 statement. “This is just the first of several issues that the bipartisan working group will tackle as a result of our review, and I believe it is the right place to start.”
The draft bill is intended to jumpstart discussions in Congress about the best way to end balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility, according to the lawmakers.
“Patients should have the power, even in emergency situations when they are unable to negotiate,” said Sen. Cassidy, a medical doctor. “Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame.”
Sen. Young noted that the lawmakers have been gauging feedback during the last several months from health care experts and other stakeholders to decide on what steps should be taken to decrease patient costs.
“This evaluation revealed that surprise medical billing is an issue we can address right away to have an immediate impact on health care costs,” Sen. Young said.
Joining Sens. Cassidy and Young in introducing the discussion draft are U.S. Sens. Chuck Grassley (R-IA), Michael Bennet (D-CO), Tom Carper (D-DE), and Claire McCaskill (D-MO).
The senators are all members of the bipartisan Senate Working Group on Health Care Price Transparency, which in April announced it received almost 1,000 pages of feedback from more than 130 groups and individuals in response to the group’s Feb. 28 letter seeking input to inform this draft legislation.
“Real world experience and evidence-based policies from health care stakeholders and experts will be important to craft a policy that most positively affects consumers and involves best practices from providers and states,” the bipartisan group wrote to stakeholders. “We all agree that health care costs are too high and now is time to move towards a system that is more open, efficient, and accountable to the needs of the modern patient.”
The input received by the working group came from a wide variety of stakeholders across the ideological spectrum, according to the group, which said in an April 18 statement that the “ideas and suggestions will help us improve and create tools and policies to ensure patients have better cost and quality information as they make choices about their health care.”
According to text of the resulting discussion draft, the bill would address:
- Emergency services provided by an out-of-network provider in an out-of-network facility: Under the draft bill a patient would only have to pay the cost-sharing amount required by their health plan, and a provider could not bill the patient for an additional payment.
- Non-Emergency services following an emergency service from an out-of-network facility: The draft bill would require that an out-of-network healthcare provider or facility notify patients that they may have to pay higher cost-sharing compared to receiving in-network services, and provide patients with the option to transfer to an in-network facility.
- Non-Emergency services performed by an out-of-network provider at an in-network facility: The draft bill would ensure that a health plan or out-of-network provider cannot bill a patient beyond their in-network cost-sharing in the case of a non-emergency service that is provided by an out-of-network provider in an in-network facility.
The discussion draft also would instruct the U.S. Secretary of Health and Human Services to conduct a study and then publicly report recommendations to Congress regarding the impact the bill would have on the prevalence of patient cost-sharing, as well as patients’ access to care and the quality of that care, among other items, according to the lawmakers’ statement.
“Increasing transparency is one of the most important steps we must take to improve our healthcare system,” said Sen. Bennet. “Patients deserve to know how much they are paying for health care services and procedures at the point of care. I’ll keep working with my colleagues to find bipartisan solutions like this to lower costs and improve patient care.”