- HHS on Wednesday prodded Congress to pass legislation that bans surprise medical billing but did not take on stance on the best method to do so or endorse any particular bill.
- In a report mandated by a June 2019 executive order on price transparency, the department stated its principles: that patients who received emergency care should not be billed extra by a provider not in their network, that patients should get information about what providers are covered before scheduled care, that patients should not receive bills from out-of-network providers they didn't choose and that the legislative fix should not increase federal healthcare expenditures.
- Congress has taken some recent action on surprise billing in the face of the coronavirus pandemic by barring the practice for COVID-19 testing and treatment during the public health emergency, now set to expire in September. Neither of the next relief packages proposed extends the ban to other treatment.
Surprise billing is not a small problem for patients. One in five people who had an elective surgery with an in-network primary surgeon over the past two years received an unexpected bill, according to a recent JAMA study. The average amount was more than $2,000.
Congress has tried to tackle surprise billing multiple times but has not been able to enact legislation to ban it. Three major drafts surfaced late last year, but have floundered.
In a call with reporters on Wednesday, senior HHS officials declined to throw their weight behind any of those bills specifically, saying it was more important to provide context for dealing with the problem.
"We have purposely tried to avoid being determinative with respect to what we believe the exact legislative outcome could be, knowing this is an active issue before the Congress and that there are strongly held views on this that are being expressed and negotiated currently," one official said.
Payers and providers say they back ending the practice, but disagree acutely about how legislation should mandate that out-of-network care be paid for.
Insurers favor using set rates, such as 125% of the Medicare amount, while providers prefer an arbitration approach for negotiating payment.
So far, state legislatures have led the way on surprise billing action and more than half of states have put forward bans. Those regulations, however, do not cover employer-based coverage, which most in the U.S. have.