Carper, Bipartisan Colleagues Work to End Surprise Medical Bills

WASHINGTON, D.C. — This week, Senator Tom Carper (D-Del.) released bipartisan draft legislation to protect patients from surprise medical bills. The draft bill is intended to jumpstart discussions in Congress about how to best stop the use of balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.

Senator Carper was joined by Senators Bill Cassidy, M.D. (R-La.), Michael Bennet (D-Colo.), Chuck Grassley (R-Iowa.), Todd Young (R-Ind.), and Claire McCaskill (D-MO), all of whom are members of the bipartisan Senate health care price transparency working group.

Recent examples of patients receiving surprise medical bills include a patient who received a bill of nearly $109,000 for care after a heart attack, and a patient who received a bill for $17,850 for a urine test.

“No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency,” said Senator Carper. “The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider. I’m proud to work with my colleagues on both sides of the aisle to ensure patients will have more transparency when it comes to the costs of their services or procedures.”

The discussion draft of the Protecting Patients from Surprise Medical Bills Act addresses three scenarios:

• Emergency services provided by an out-of-network provider in an out-of-network facility: The draft bill would ensure that a patient is only required to pay the cost-sharing amount required by their health plan, and a provider may not bill the patient for an additional payment. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.

• Non-Emergency services following an emergency service from an out-of-network facility: The draft bill would ensure that if a patient receives an emergency service from an out-of-network health care provider or facility and requires additional services after being stabilized, the health care facility or hospital will notify the patient, or their designee, that they may be required to pay higher cost-sharing than if they received an in-network service and give the patient an option to transfer to an in-network facility. The patient, or their designee, would also be required to sign a written acknowledgment of that notification.

• Non-Emergency services performed by an out-of-network provider at an in-network facility: The draft bill would ensure that a health plan or out-of-network provider cannot bill a patient beyond their in-network cost-sharing in the case of a non-emergency service that is provided by an out-of-network provider in an in-network facility. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.

This discussion draft would also instruct the  secretary of Health and Human Services to conduct a study and issue a public report that includes recommendations to Congress regarding the impact the bill would have on the prevalence of patient cost-sharing, patients’ access to care and the quality of that care, the price of insurance premiums, any change in overall health care costs, the use of emergency rooms, access to new and improved drugs and technology, the adequacy of insurance networks.