COMMENTARY

Surprise Medical Bills -- How Should They Be Addressed?

Alok Patel, MD

Disclosures

July 12, 2019

This transcript has been edited for clarity.

Surprise medical bills shouldn't exist. Yet, in a recent survey, almost 60% of Americans reported receiving one.[1] You all know how it goes. The patient racks up thousands of dollars' worth of hidden fees from an unexpected out-of-network charge.[2] It's a rampant problem and bankrupting Americans. So it's no surprise that fixing it is a bipartisan priority. Democrats and Republicans finally agree on something!

Several bills and policy changes have been proposed. Here are a few.

One draft bill would straight up prohibit balance billing emergency departments and require them to notify patients if they're in an out-of-network facility. Another, similar bill would limit a hospital's ability to charge more for an emergent out-of-network procedure than they would for a similar in-network procedure.[3] A third bill would force hospitals to notify patients within 24 hours if they're in an out-of-network hospital or if any members of their care team are out of network, and then notify patients what they can be expected to pay out of pocket.

In my opinion, all of these bills are on the right track. I get so angry when patients do the responsible, right thing—research their network, do the best they can—and then wind up with a $100,000 bill because one specialist happened to be out of network.

During a recent House subcommittee hearing, the point was made that hospitals and medical groups should be limited in how much they can charge for out-of-network services. I mean, some of these astronomical charges just seem made up. And obviously health plans need to cover a little bit more. We can't burden patients to sit and research whether every member of their care team is in network and then expect them to negotiate out-of-pocket surprise bills. We need to fix the problem at its root.

So, doctors, two questions: First, what plan would you support, or policy change would you put forward, to fix this problem? Second, what are you doing right now to protect your patients from surprise medical bills? Share your ideas.

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