WASHINGTON – In case you missed it, Senator Maggie Hassan spoke with Sarah Kliff of Vox about new legislation she introduced to address surprise medical bills, which pose a financial burden to far too many Granite Staters and Americans who receive massive, unexpected medical bills, often for receiving care that they didn’t realize was considered out-of-network.
Senator Hassan’s No More Surprise Medical Bills Act of 2018 would help eliminate surprise medical bills for people with employer-sponsored health plans. The bill will protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount. The bill also protects patients in non-emergency situations from surprise bills by requiring hospitals and providers to notify patients if services will be out-of-network and get their consent. Without proper notification and consent, a provider can only charge a patient the in-network amount. If payment disputes arise when these rules aren't followed, the legislation would establish an independent entity to resolve disputes between providers and health insurance plans, without putting patients in the middle. This dispute resolution system is based on a "baseball-style" or “final offer” model, where the provider and insurance plan submit their best and final offer, and the independent entity must choose one of the offers. This model helps incentivize providers and plans to come to a reasonable amount.
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By Sarah Kliff
There is a growing outcry on Capitol Hill over surprise emergency room bills — and more senators on both sides of the aisle who want to do something about it.
[…] Sen. Maggie Hassan (D-NH) introduced a bill this month that would aim to end surprise emergency room bills. She says her bill was inspired by Vox’s database of 1,600 emergency room bills and the stories written about it.
[…] I recently spoke with Sen. Hassan about her new bill, where she thinks it’s heading next, and the role of Vox’s ER Billing Database in all this. What follows is a transcript of our conversation, lightly edited for clarity and length.
I’d like to start with how you got interested in emergency room billing. How did you decide that this is something you wanted to introduce legislation on?
Sen. Maggie Hassan
It’s unacceptable that people in New Hampshire or anywhere in the country are faced with surprise medical bills, surprise bills for care they thought was covered or in-network. This is a fight between the insurance plan, and the provider with the patient stuck in the middle. It shouldn’t be an issue that the consumer gets stuck with. We know from recent surveys that surprise medical costs are one of the top issues facing consumers. And your reporting, I think, has helped bring attention to the issue. It really wasn’t getting enough attention from policymakers.
Let’s talk about the policy that you settled on, which is different from some other bills floating around on this topic, like the one from Sen. Cassidy that you mentioned. Your bill would require insurers and providers to go to an impartial arbiter, name what they think is a fair price, and let the arbiter decide which price to go with. Why is that a good policy solution?
I thought it was important to think of a way we could remove the consumer from what is really a dispute between a provider and a health plan. That requires some kind of mechanism to reach an agreement about what the bill should be. In a system where charges are often not connected to market forces, it seems like an opportunity for an independent dispute resolution process. You essentially use the baseball model [which gets its name from the way Major League Baseball settles payment disputes between players and teams].
This is pretty different from the idea that Sen. Bill Cassidy and Sen. McCaskill are proposing in their bill, which would essentially use existing health care prices to set limits on what out-of-network providers could charge. What do you like better about your approach?
First, I want to say that I appreciate there is bipartisan interest in this issue. And I really do look forward to working with my colleagues to address this issue in some kind of comprehensive package of legislation.
The thing that concerns me about their approach is that we have a baseline where the rates are already quite high. They’re using numbers that are already detached from market forces, and too high in many instances. So I’m concerned we might just end up propping up health care inflation if we go that route. They might have comments on our approach too.
So where do things go from here? How does something like this make its way to becoming law?
We have senators and staff talk through the issue. I think what we’ll be looking for on the HELP committee is a hearing on some of these ideas. We’ve had a number of hearings on health costs generally, but I think members of both parties will be asking to open up hearings on this specific issue of surprise billing. Given the bipartisan attention, the fact we’re hearing story after story about this, it needs to be addressed.
I recently had a constituent write in that she went to the ER with kidney stones, paid according to her in-network requirements, and all of a sudden several months later she gets a bill because the radiologist was out of network. We want somebody with kidney stones having to negotiate in the ER?
I think those kind of examples are going to bring a lot of policy makers to the table.
I don’t think the American public is used to Congress working together in a bipartisan way on health care issues. But it sounds like this could be different?
Well, the HELP Committee just passed comprehensive opioid legislation, we just did the Perkins bill, I think we have a good track record on working across the aisle.