Closing the loopholes that permit devastating surprise medical bills


In an outbreak of bipartisanship, senators have unveiled draft legislation meant to protect consumers from unexpected massive medical bills. Those surprise bills are usually due to patients being seen by doctors who are “out-of-network” and not contracted with the patient’s insurance. Although states have laws preventing these situations, the key story here is that state laws do not regulate health plans offered by “self-insured” employers and unions. These health plans are governed only by federal law. And today 61% of privately insured Americans get health insurance through self-funded, self-insured employers and other such organizations. Some recent egregious cases of surprise bills occurred in situations where the patient had a self-insured employer plan. Today Federal law does not prevent “balance billing” in these cases. The new legislation proposes a) preventing balance billing for care received during emergencies; b) prohibiting balance billing from out-of-network providers who are delivering care to patients how are in a hospital that is in network with the patient’s insurance; c) required written notification of patients (after they are medically stable) when they are receiving emergency care in hospital that is not in their insurance network.


Read: Bipartisan senators unveil proposal to crack down on surprise medical bills

Read: Balance Billing - Wikipedia

Read: Life-Threatening Heart Attack Leaves Teacher With $108,951 Bill, and Happy Ending.

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