Washington, D.C. – Around the country, too many Americans are receiving medical bills they didn’t plan for. Drew Calver, a teacher from Texas, was rushed to an out-of-network hospital when he had a heart attack. Afterwards, he was hit with an eye-popping surprise bill of $108,951. The Energy and Commerce Committee heard a surprise billing story firsthand from Sonji Wilkes. She had given birth at an in-network facility and her son was sent to the NICU for treatment. However, the NICU was not in-network and Wilkes and her family had to grapple with a $50,000 surprise medical bill. Watch her tell her story HERE.
How are patients getting stuck with surprise bills? It often happens when an insured patient is treated in an in-network medical facility by a medical professional not in their network. This can also happen in emergency situations when a patient is taken to a facility that is not in-network. Their insurance company may foot part of the bill, but the provider may turn around and put the patient on the hook for the rest, through a practice known as balance billing. In fact, around 1-in-5 emergency room patients are hit with surprise bills.
As E&C GOP Leader Greg Walden put it “…the system is being gamed and the consumers are losing…” After hearing of how patients were being gamed, E&C and the Senate Health, Education, Labor, and Pensions (HELP) Committee worked to reach a bipartisan, bicameral agreement to end surprise billing that was backed by the White House. That legislation remains our best chance at protecting patients from the financial devastation that can come with a surprise medical bill, and President Trump agrees.
Fortunately, there are some protections for patients from surprise billing now tied to the COVID-19 pandemic. Congress has made COVID-19 testing free for everyone regardless if you have insurance or not. On top of that, if a provider accepts money from the “Provider Relief Fund” – a fund Congress has given $175 billion to help providers with COVID-19 challenges – then any of their COVID-19 patients cannot receive a surprise bill.
Walden praises the surprise billing protections for COVID-19 patients but argues in a Wall Street Journal article that protections should be for all patients – not just COVID-19 patients during a pandemic.
“There’s a certain irony here that we were able to put into statute that you can’t surprise-bill a Covid patient and nobody objected, but if you have a heart condition that pops up and you’re out of network, it’s OK? I don’t think so,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We’ve won the intellectual argument.”
Even during a pandemic, patients without COVID-19 in similar situations to Wilkes and Calver are most likely still being gamed by the system. It’s time to pass the No Surprises Act and protect consumers from this practice once and for all.
You can read the full Wall Street Journal piece HERE.