Fact Sheet: Patients Should Not Settle for Subpar Patient Protections against Surprise Medical Billing
Patients Should Not Settle for Subpar Patient Protections against Surprise Medical Billing
- A substantial effort is underway by some in the House to include legislation to address surprise medical bills in a year-end package. This attempt is being made during a public health crisis and would benefit insurance companies by stripping nearly $20 billion from providers serving on the front lines of the COVID-19 pandemic. Meanwhile, hospitals, physicians and other providers continue to seek common ground on this important issue.
- Hospitals and health systems are deeply concerned about the effect of unanticipated medical bills on our patients, which could impact their out- of-pocket costs. Protecting patients from surprise medical bills is a top priority for the AHA and all of our members. Equally important to the AHA is patient access to hospital care.
- However, we oppose legislative proposals that set a default payment rate for out-of-network services. While no legislative language has been provided, we understand the proposal would include a prohibition on balance billing and rely on rate setting to establish an initial payment, with an opportunity for providers to dispute the payment.
Congress should not include in any end-of-the year legislation harmful provisions that rely on an arbitrary government rate, as this would jeopardize patient access to hospital care.
The latest “solution” would strip $17 billion to $20 billion from providers.
80% of these “savings” would come from in-network providers — the very providers who cannot surprise bill patients.
- And patients would likely not see a dime. The money would go to insurers, and nothing in the legislation would stop them from adding it to the record profits they’ve amassed during the COVID-19 global pandemic by pocketing patients’ unspent premiums.
- Instead, Congress should protect patients from surprise medical bills while preserving the appropriate role of providers and insurers in negotiating payment rates.
AHA Provides Additional Recommendations Regarding the No Surprises Act Independent Dispute Resolution Process
Key House Committee Expresses Serious Concerns Regarding Latest Efforts to Implement the Bipartisan No Surprises Act