Helping Patients with Surprise Bills

Mar 03, 2016 - 10:43 AM

Today’s TIME Magazine story on surprise bills highlights an important issue confronting many patients in the course of their care. The AHA believes patients and their families should be protected from the financial burdens of unexpected bills. This requires everyone providing a health care service to help consumers navigate the complicated heath care delivery system. Insurers, in particular, have the primary responsibility for making sure their networks include adequate providers and that hospital-based physicians are included in their directories and on their websites. And, they need to communicate those parameters to consumers.

Hospitals also play a key role by informing patients in their facilities that they may be treated by non-network physicians. Additionally, to help ensure that patients can get all the information they need, the AHA joined in the Patient Financial Interactions Best Practices Project, a multi-stakeholder task force convened by the Healthcare Financial Management Association that included providers, insurers and consumers because it is important to have guidance that helps hospitals assist patients with sensitive financial interactions. 

AHA also supports the National Association of Insurance Commissioners’ model legislation that would use a structured mediation process to address out-of-network bills. Many states, such as New York and Texas, have implemented policies to help consumers that include:

  • requiring transparency and disclosures from insurers and providers,
  • initiating an arbitration process between insurers and physicians that gets the consumer out of the middle

These state-based solutions are helping provide consumers with needed relief as well as offering an outlet to amicably settle out-of-network bills. Hospitals are also helping the patients they serve by providing transparent billing information. Working together across the health care system, there is still more to do to end consumer surprise and improve billing transparency. As with all information that consumers need to make good health care and treatment decision, the AHA’s remains strongly committed to the goal of transparency

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