Concern over surprise medical bills—those from out-of-network physicians that patients had no role in choosing—has grown tremendously in recent years. Some states have taken steps to mitigate this problem. However, these measures do not apply to the roughly half of Americans enrolled in self-insured health plans because ERISA precludes states from regulating these plans.
A bipartisan group of six senators recently introduced a bill to target three key consumer concerns:
- Treatment for an emergency by a non-network doctor at a non-network hospital. Patients would be required to pay out-of-pocket the amount required by their insurance plan. The hospital or doctor could not “balance bill” the patient.
- Treatment by a non-network provider at an in-network hospital. Patients would pay only what is required by their plans.
- Mandated notification to emergency patients, once they are stabilized, that they could run up excess charges if they are in an out-of-network hospital. The patients would be required to sign a statement acknowledging that they had been told their insurance might not cover their expenses, and they could seek treatment elsewhere.