“Surprise Billing Won’t Go Away Unless Congress Acts” – Coalition Members Reinforce Urgent Need for Congressional Action on Surprise Billing

In a new letter to Congressional leaders, the Coalition Against Surprise Medical Billing urged policymakers to take immediate and comprehensive action to end surprise medical billing as millions of Americans face the looming threat of these bankrupting charges during the COVID-19 crisis.

Members of the Coalition Against Surprise Medical Billing, which represent leading employer groups, unions, health insurance providers, health organizations and the tens of millions of people they employ and serve each day, support meaningful solutions to end surprise medical billing. The Coalition has advocated for comprehensive patient protections and fair, market-based payments as core steps that policymakers could take to address the unfair, costly charges. Leading consumer and national employer groups have also called on Congress to take immediate action on surprise billing reforms as the COVID-19 pandemic continues.

Highlights of the Coalition’s letter are included below:

Loopholes in previous COVID-19 relief legislation and regulatory guidance give out-of-network providers and private equity firms an easy pass to balance bill patients.

• The Trump Administration established common-sense guardrails for providers that accepted federal funding as part of the COVID-19 relief packages – and the HEROES Act takes that guidance a step further by incorporating those provisions into potential federal law. However, those policies have significant limitations.
• The initial regulations do not apply if a provider or private equity-backed staffing firm chooses to forego federal funding, leaving many patients still at risk for a surprise medical bill, especially if they receive non-COVID related care from an out-of-network provider in the midst of the pandemic. Recent news coverage has highlighted in detail how some private equity-backed providers are still looking to take advantage of patients.
• Further, Congress is aware of media and other reports about questionable practices and pricing specific to COVID-19 tests and related care. In response, it has sought information to further understand the vulnerabilities facing patients in light of an incomplete legal and regulatory surprise billing framework.

The cost of COVID-19-related care continues to increase, raising concerns about an unprecedented affordability crisis. 

• Even before the COVID-19 crisis, two-thirds of Americans were worried about being able to afford an unexpected medical bill. The risk of a bankrupting medical bill is real – especially today, as Americans face the risk of a bill from an out-of-network provider during an emergency, during surgery, and even during a stay at an in-network hospital.
• The COVID-19 pandemic exacerbates those financial fears. The estimated cost of coronavirus in-patient treatment for an individual patient is more than $20,000, according to the Kaiser Family Foundation. For patients in “hotspots” across the country where COVID-19 cases continue to surge, the range in costs associated with hospital stays will leave a disproportionate financial burden on the most vulnerable Americans.

The best way to financially protect patients and American workers from exorbitant medical costs associated with this and future outbreaks or pandemics is to put essential safeguards in place now that allow us to focus on strengthening our response in the future.

• This is accomplished by establishing fair, market-based payments for out-of-network reimbursement, which ensures that all Americans can benefit from protections against egregious pricing for essential medical care. It also extends vital protections against surprise medical bills during unexpected emergencies and for care provided at an in-network hospital.
• Both of these critical steps can put our health system and the country on stronger footing to make sure that we are delivering on our number one priority – getting patients and their families the critical care that they need when they need it.  
• Fair, market-based pricing would also generate $25 billion in savings back to taxpayers, employers and families – instead of producing a windfall for private equity firms – and is the right thing to do on behalf of millions of Americans and patients.

To view the full letter, click here.