Imagine going to the hospital after fainting and cutting your ear on a table. In the emergency room you’re treated with an ice pack and an Ace bandage but decline further treatment after realizing the providers are out of network for your insurance. Months later, you receive a bill in the mail for $5,751. Nearly $6,000 — for an ice pack and bandage.
That’s exactly what happened to Jessica Pell of Hoboken, N.J., in 2016. Upon receiving the bill Pell’s insurance company determined that a fair payment for her treatment was $862 and paid the hospital. That should have been the end of it, but more than a year later Pell received a $4,989 bill for the balance of her treatment costs. She couldn’t afford this outrageous bill, and it was only after the hospital was contacted by a reporter that the charges were reversed.
Sadly, stories like this are all too common. In Oregon, Debbie Moehnke was hit with a startling $454,000 medical bill after a heart attack brought her to a hospital in Portland. After her insurance company paid its part, she was left with nearly $227,000 in surprise bills. She and her husband had good health insurance, but since she was taken to a hospital out of her network, the charges for the life-saving emergency services piled up.
Year after year millions of Americans are affected by surprise medical bills like the ones Pell and Moehnke received. In fact, roughly one in every six hospital visits results in a surprise medical bill and a majority of Americans say they or someone they know have received a surprise bill. These are particularly alarming figures considering two-thirds of people who file for bankruptcy cite medical issues as a key contributor.
These bills are the result of a broken system that takes advantage of patients, which we can no longer accept as business as usual. That’s why we’ve introduced bipartisan legislation to shield patients from these outrageous bills and establish a fair payment system between insurers and providers.
The No Surprises Act would protect insured Americans against surprise medical bills and limit patients’ out-of-pocket costs rates during emergency situations. This would have prevented both Pell and Moehnke from receiving the outrageous out-of-network charge for their emergency services. It would also protect patients who make an appointment at an in-network facility only to later receive a surprise bill from a provider like an anesthesiologist or a radiologist, who they did not know was out of network and had no say in choosing.
The No Surprises Act eliminates these types of surprises by taking patients out of the middle of these disputes that should occur between insurers, hospitals and providers. The legislation would establish a fair, market-based payment system using local in-network rates and would allow providers to appeal for a higher reimbursement with an independent arbiter in certain circumstances.
This is a commonsense approach to ending surprise medical bills, and that’s why it received unanimous support in the House Energy and Commerce Committee back in July. A similar bill passed out of the Senate Health, Education, Labor and Pensions Committee earlier this year.
The No Surprises Act will not only save consumers money by lowering health care premiums, but according to the Congressional Budget Office, it will also save the federal government more than $20 billion over the next 10 years. These tremendous savings could be used to reinvest in our nation’s health care system and cut costs for consumers.
Our goal is simple: stand up for what’s fair and right for the consumer who has followed all the rules. After unveiling our bipartisan proposal, anonymous dark money groups began spending tens of millions of dollars on advertisements intended to mislead consumers and derail our efforts to put an end to surprise medical bills. While these dark groups were shrouded in mystery at first, we now know that they were funded by private equity backed physician staffing companies that happen to be responsible for some of the worst surprise medical billing practices in the industry.
Let us be very clear: These scare tactics did nothing to slow our work to protect patients. To the contrary, we launched a bipartisan congressional investigation into practices surrounding surprise billing, including the role that private equity firms appear to be playing in physician staffing.
The American people have had enough, and so have we. The No Surprises Act has widespread support from patient advocates and nearly 9 in 10 voters support legislation to stop surprise medical bills.
We are very close to answering that call for action from the American people, and are engaged in productive, regular discussions with our Senate counterparts to find a path forward. This is a health care priority that is bringing together Republicans and Democrats in Congress and President TrumpDonald TrumpHeadaches intensify for Democrats in Florida Stormy Daniels set to testify against former lawyer Avenatti in fraud trial Cheney challenger wins Wyoming Republican activists' straw poll MORE.
People are getting ripped off and we are going to protect patients from surprise billing — we are committed to seeing this through.
Pallone Jr. is chairman of the Energy and Commerce Committee and Walden is ranking member of the Energy and Commerce Committee. Pallone and Walden introduced the bipartisan No Surprises Act earlier this year to protect patients from surprise medical bills. The bill was favorably voted out of the Committee with unanimous support in July and is awaiting consideration on the House Floor.