Hospitals, Payers Must be Held Accountable For Surprise Medical Bills

Surprise Medical BillsPresident Donald Trump said it’s time for Congress to pass a law that stops hospitals and insurance companies from hitting patients with surprise medical bills.

“We’re going to hold insurance companies and hospitals accountable,” Trump said during a news briefing Thursday.

A bipartisan group of senators have been working on a bill addressing the issue, with the plan to have it to Trump sometime in July, according to Kaiser Health News.

But physician advocacy groups, including the American Medical Association (AMA) while applauding the effort to eliminate surprise medical bills, expressed some concern that a simplified approach to a complex problem could have unintended consequences for healthcare delivery.

There has been widespread media attention in recent years on patients receiving outrageous bills after getting treated by an out-of-network  doctor even though they went to an in-network facility. According to Health Affairs, one in five emergency department visits leads to a surprise medical bills. Nine states now have some protections in place to guard patients against surprise medical bills, according to the Commonwealth Fund.

“We agree with the president that patients should not be responsible for coverage gaps and for any costs beyond their in-network cost sharing when they do not have an opportunity to choose an in-network physician,” said Barbara L. McAneny, MD, AMA’s president in a statement. “We also agree that physicians and hospitals should be transparent about their costs, and payers should offer transparency about their networks, scope of coverage, and out-of-pocket costs. In addition, insurers should be held accountable for their contributions to the problem and ensure network adequacy, adherence to the prudent layperson standard for emergency care in current law, and reasonable cost-sharing requirements.”

“Some of the principles raise more questions than answers, however,” McAneny continued. “For instance, while the idea of a single bill sounds appealing, putting that into practice could have significant unintended consequences.”

Despite the bi-partisan congressional effort and general stakeholder agreement that surprise medical bills need to end, hurdles to enacting a solution remain. Hospitals and payers have fundamental disagreemention how the problem should be fixed, and it is unlikely lawmakers could come up with a solution that keeps both sides happy, according to a report from Kaiser Health News.

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