Insurer-backed coalition forms to push efforts to stem 'surprise bills'

Surprise bills
With the problem of surprise medical bills garnering growing national scrutiny, a group of insurance, business and consumer groups announced they've banded together to push for stronger patient protections against so-called balance billing. (Callie Richmond for KHN)

With the problem of surprise medical bills garnering growing national scrutiny, a group of insurance, business and consumer groups announced they've banded together to push for stronger patient protections.

Led by the likes of America's Health Insurance Plans, the National Business Group on Health and the Consumers Union, the new coalition is seeking legislative remedies such as requiring that patients be informed when care is out of network and know the cost of their treatment and options.

Other organizations in the nine-member coalition include the American Benefits Council, the Blue Cross Blue Shield Association, the ERISA Industry Committee, Families USA, the National Association of Health Underwriters and the National Retail Federation.

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

RELATED: Harvard researcher tells Congress surprise billing ‘ought to be illegal,’ urges federal policy shift

The coalition said they are agreeing to guiding principles, including backing: 

  • Federal legislation to protect patients from surprise bills. 
  • Policy changes to ensure that patients are informed when care is out of network.
  • Policy changes to protect patients from increasing premiums or other costs as a result of policies enacted to protect them from surprise bills.
  • A federal standard for payments to out-of-network doctors to help protect patients in self-funded health plans.

It's the latest in the back and forth in the industry over who is actually to blame for surprise medical bills. As Kaiser Health News reported this fall, plenty of hospitals use something called balance billing to charge patients the difference between what the hospital and the insurer think their care was worth for out-of-network patients. (In-network hospitals are required to accept recontracted rates.)

RELATED: The remedy for surprise medical bills may lie in stitching up federal law

The coalition was met with early criticism from hospitals groups. American Hospital Association CEO Rick Pollack and Federation of American Hospitals President and CEO Chip Kahn said in a joint statement that the coalition "mischaracterizes" the cause of surprise bills.

“Hospitals and health systems want to protect their patients from surprise bills. Consumers, health insurers, employers, and hospitals all agree on that and need to find a common ground solution," they said. “Inadequate health plan provider networks that limit patient access to emergency care is one of the root causes of surprise bills. Patients should be confident that they can seek immediate lifesaving care at any hospital."

They said they were also looking forward to policy solutions to surprise bills.

Earlier this year, a coalition of doctors took aim at the problem, pressing for more states to adopt legislation to solve it. Physicians for Fair Coverage is a nonprofit, nonpartisan, multispecialty alliance of physician groups which blamed insurers for the problem.

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