- The House Energy and Commerce Committee is expanding its investigation into surprise billing practices by calling on some of the nation's largest insurers and physician staffing firms to provide information and documents on the practice, lawmakers said Thursday.
- The committee sent letters to UnitedHealth Group, Anthem and Cigna asking for information about in-network and out-of-network pricing and the frequency of surprise billing in their plans.
- Private-equity backed Envision Healthcare and Team Health also received letters from the committee.
Despite bipartisan support to eliminate surprise billing, Congress has punted the issue to next year, amid competing congressional proposals and pushback from doctors, hospitals and insurers.
Senate Health Committee Chairman Lamar Alexander, R-Tenn., said in a statement Monday it will be a top legislative priority next year.
Still, the House Energy and Commerce Committee is pushing ahead on investigations to better understand the forces behind the practice that can sometimes leave patients on the hook for pricey medical bills after they inadvertently get out-of-network care despite being at an in-network facility.
"We are concerned about the impact of surprise billing on the nation’s rising health care costs and the devastating effect that the practice is having on Americans," the leaders of the committee said in a statement on Thursday.
The committee has requested insurers and physician staffing groups answer a slew of questions and provide them to the committee no later than Jan. 9, according to the letters.
Of the letters sent to insurers, one question asks for how many beneficiaries were responsible for an out-of-network bill despite receiving care at an in-network facility over the past five years.
The committee is seeking a comprehensive list of facilities and providers that have agreed to in-network works and a list of the physician staffing firms that work at those hospitals and have also agreed to in-network rates. It also wants to know the average in-network reimbursement rate for each of the physician services covered by the plan that are provided by the physicians affiliated with a physician staffing company.
The issue of surprise billing has garnered numerous studies and attracted the attention of lawmakers and the press reporting on families stuck in the middle slapped with eye-popping bills.
Research has shown that surprise bills are somewhat common. As many as one in five emergency room visits results in a surprise bill, according to Health Affairs. Nearly 70% of air ambulances were out-of-network in 2017, according to a separate government report.
Another recent study showed that if some specialties were banned from billing out-of-network charges, healthcare spending for those with employer-sponsored insurance would fall by 3.4%, or about $40 billion annually.