In a case that was reported to the Kaiser Family Foundation ─ a non-profit healthcare issues thinktank ─ a Texas high school history teacher emergency treated for a heart attack with stent implants in 2017 received a ‘surprise’ medical bill for US$108,951 from providers he knew nothing about. That was in addition to the $55,000 paid by his insurer to the treating hospital. After taking his case to the media, the teacher’s bill was reduced to $332.
Such stories are not unusual in the US. These situations occur most often under emergency conditions when patients don’t have the time or ability to select their service providers ─ some of whom may not be participants in their insurer’s approved network, or who may only be visitors to the US under cover of international travel insurance and therefore not subject to the network’s fee limits. It has also happened to patients in non-emergency settings who were simply not advised beforehand that an out-of-network specialist or physician may be brought in to provide services.
In states such as New York, where controls on ‘surprise’ billings were enacted in 2015, the issue has been markedly controlled, as it has in the dozen or so states that have passed similar laws since then.
But comparable legislation at the federal level, covering the nation as a whole, has been largely stonewalled, partly by party politics, as well as lobbyists hired by doctors’ groups or hospitals.
Still, in 2017 and 2018, legislators from both parties in the House and Senate have floated bills to end surprise medical billing. And in May this year, Trump called on both Democrats and Republicans to end the practice of surprise medical billing, stating that ‘No family should be blindsided by outrageous medical bills’.
The bills have differed in their intended methods of settling disputes: some limiting out-of-network charges to those being paid by patients’ primary insurers; others submitting them to third party unaligned entities; others to binding arbitration. Whatever the method, the mantra remains: Get the patient out of the middle.”
One of the House bills would also prohibit surprise charges for ground or air ambulances called in during emergencies. That bill cited the case of a $40,000 charge for an air ambulance brought in to handle a local emergency as being particularly odious.
But this being election season (leading up to November 2020) the ‘stop surprises movement’ has hit a further snag as lobbyists representing physicians’ associations (especially surgeons, ER specialists, anaesthesiologists and radiologists ─ providers of the bulk of emergency services in hospitals), as well as hospitals and doctors’ staffing companies, have descended on Capitol Hill and the local offices of Congressmen and Senators, to stifle any action and hopefully defer the momentum to the next Congress ─ better yet the next.
One so-called ‘dark-money’ group, representing mostly ER physicians, has reportedly spent $14 million on television ads attacking the various Senate and House bills. And, according to the Center for Responsive Politics (a non-aligned health affairs think tank), the American Hospital Association has spent $10.2 million and the American Medical Association $11.5 million on their lobbying efforts against various components of the ‘stop surprises’ efforts.
And though Congress itself has shown unity on this issue, there are the organic realities of election politics to be dealt with: Republicans still reeling from their failure to repeal Obamacare when they had the chance, and Democrats determined not to hand President Trump a Win on a healthcare issue going into his own election efforts.
As for patients, will they remain caught in the middle?