Hospital groups push for seat at table as lawmakers address 'surprise billing'

It's the latest in the back and forth in the industry over who is actually to blame for surprise medical bills. (Getty/peterspiro)

As the problem of "surprise billing" at hospitals around the country gains scrutiny from the White House and Congress, a collection of major hospital groups indicated they want a hand in shaping the conversation.

In a letter sent to Congressional leaders on Tuesday, the groups—which include the American Hospital Association and Federation of American Hospitals—laid out principles they want lawmakers to consider as they seek to address the problem over the next few months.

Specifically, their solutions took aim at policies by health payers and called for protections for patients but notably also opposed the controversial practice of balance billing by providers.

It's the latest in the back and forth in the industry over who is actually to blame for surprise medical bills, or the practice of charging patients for care that is more expensive than anticipated or not covered by their insurance. In December, a group of insurance, business and consumer groups announced they'd banded together to push for stronger patient protections and released their own guiding principles for the conversation.

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"We are fully committed to protecting patients from “surprise bills” that result from unexpected gaps in coverage or medical emergencies," the letter from the hospital groups, which also included America’s Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States and the Children’s Hospital Association said.

"We appreciate your leadership on this issue and look forward to continuing to work with you on a federal legislative solution," they said.

Among the principles, they called for:

  • Congress to define "surprise bills" saying they may occur when a patient receives care from an out-of-network provider or when their health plan fails to pay for covered services. They also called for policies to protect patients financially and said providers should not balance bill, meaning they should not send a patient a bill beyond their cost-sharing obligations.
  • Protections for patients seeking emergency care from being denied payment by a payer if, in retrospect, the health plan determines was not an emergency. They also supported moving the patient from health plan/provider negotiations, saying health plans must work directly with providers on reimbursement, and the patient should not be responsible for transmitting any payment between the plan and the provider.

  • The preservation of the role of private negotiation between health plans and providers in determining appropriate payment rates.

    "The government should not establish a fixed payment amount or reimbursement methodology for out-of-network services, which could create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks," the groups wrote. 
  • Ensuring patients have access to comprehensive provider networks and accurate network information through their health plans. Hospitals have received criticism that surprise bills have resulted in emergency departments or surgical procedures when a patient receives care in an in-network hospital by an out-of-network healthcare provider.

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

The letter came the same day as a Brookings Institution report which said 1 in 5 visits to the emergency department results in a surprise out-of-network bill in states that don't prohibit them. About half of all ambulance cases involved an out-of-network ride in 2014, according to the report.

The report was highlighting state-level policy options which could help mitigate the costs of surprise out-of-network billing.