July 17, 2019

From the Desk of Bob McNett…

Congress Addresses “Surprise Medical Bills” in Controversial Hearings.

Many patients get blindsided by “Surprise Medical Bills”  after they go home from the hospital or emergency room and get their bills in the mail.

These “surprise” bills come from doctors and other medical providers that treat the patient that are not in the insured’s managed care network. 

These providers often charge fees that are much higher than the patient’s health plan will allow, even those with strong employer-based coverage.  Patients can negotiate with the medical providers to bring the fee down, but the non-network provider is not obligated to reduce their charges.  If an agreement cannot be reached, the unpaid fees often go into collections.

One in six emergency room visits result in an unexpected bill from a non-network provider.  Some times emergency rooms that provide 24 hour services to the public have to staff their ER’s with a few doctors that do not have a contract with all the major health insurers.  This can result in a billing, sometimes very large, that the patient did not expect.  Your chances of getting one of these bill varies greatly depending on what state you live in.

Now Congress is taking up the question of how to fix this long-standing problem.

There are two basic approaches being proposed

1) A non-network provider, under one proposal, would have to accept the network fee negotiated between the insurer and providers that do have a contract with the insurer.  A  non-network provider could not charge more than what a network provider receives for the same procedure or service.  Deductibles and copays would still apply.

2)  A second approach would set up an arbitration process where an expert third party would hear from the patient, insurer and provider and then come to a compromise to a final fee.

Insurers tend to support the first approach, medical provider the second.

Congressional hearings where insurers and providers have testified have been highlighted by acrimonious exchanges between the two interest groups.  Legislators  have expressed frustration over these interest groups unwillingness to come to an agreement.  President Trump has expressed his willingness to sign a bill when it is delivered to his desk.

However, it looks like the momentum is building to pass a bill soon through both houses of Congress.

We will keep you informed as this issue comes to a conclusion.

Robert K. McNett, LUTCF

The McNett Agency

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