Several lawmakers issued warnings Wednesday to industry leaders—including payers and hospitals—to figure out how they can stop patients from being stung by unexpectedly high medical bills before Congress has to step in.
House Energy and Commerce Committee Ranking Member Rep. Michael Burgess, R-Texas, acknowledged different parts of the industry have good reasons to disagree. But, he said, "if you don’t help us solve the problem, we will solve the problem and none of you will like it." His comments sent the tone of increasing frustration among lawmakers and consumer advocates in a morning and afternoon of testimony from medical experts about the potential impact of the No Surprises Act.
"We’ve all heard the stories. Patients who follow the rules. They pay their premiums. And then through no fault of their own, following some sort of emergency situation or surgery, receive a six-digit bill in the mail weeks later which they have no way of paying," said Rep. Greg Walden, R-Ore., who introduced the bipartisan legislation up for consideration before an Energy and Commerce subcommittee. "It is not fair. It should not happen and we’re going to put a stop to it one way or the other."
The measure would prohibit balance billing of patients and limit a patient’s bill to their in-network cost sharing amount in emergency situations. It would also require providers give patients both verbal and written notice of any out-of-network providers who will be involved in their planned care, such as for elective surgery, and require providers to be paid by the patient's insurer at a median in-network rate for the service they provided in that geographic area in the event of a dispute.
Concerns raised largely centered around whether some form of arbitration would be a better solution—an idea the American Hospital Association favors—or if benchmarking rates is a better idea, which America's Health Insurance Plans backed.
Arbitration is used in New York, and a recent study found that consumer complaints about balance billing declined significantly in the state as a result. Providers in the state were more enthusiastic about the program than insurers, but case winners were evenly split between the two. Still, payers have warned that would create a costly bureaucratic system that would ultimately increase prices for consumers.
Lawmakers were also clearly frustrated as they sought specific answers, such as how to calculate average prices that hospitals, doctors and payers could all agree to. "Why is it we can’t find an average when we start negotiating prices?” Markwayne Mullin, R-Okla., asked. “If y’all don’t want to solve it, we’re going to. All we’re saying is, do it. Solve it."
Patient advocate Sonji Wilkes told her story about getting smacked with a $50,000 bill after her newborn son was diagnosed with hemophilia and spent several days in the neonatal ICU. The hospital where she'd delivered him was in-network, but the subcontracting company that ran the NICU just down the hall was not, she said.
During the hearing, Wilkes was asked to relate her thoughts as to what sort of congressional oversight was needed as experts parsed the problem. She responded with what sounded like exasperation.
"I’ve been sitting here thinking, 'I pay my insurance premiums. I do my part and I expect the bill to be paid. There’s only so much I can do to control that'," Wilkes replied. "I don’t really care how the reimbursement works and quite frankly I think the insurance industry is probably doing better on their bottom line than my bottom line. I want to go to the best provider possible and I want to get the best care possible. I don’t really care how the payment works."
Interested in watching the hearing? Find a playback below: