Surprise Medical Bills

Patients can’t choose when and where an emergency may happen, and they shouldn’t be punished financially for it. Under federal law, emergency physicians must treat any patient who walks into the emergency department before there is any discussion of payment or insurance status. For most emergency physicians, the thought of payment never crosses their mind—they are there to help, potentially save your life.

To end surprise billing, Congress must protect patients, level the playing field and improve transparency. In January 2019, the American College of Emergency Physicians (ACEP) released specific recommendations to Congress that protect patients when emergency care is out-of-network.

ACEP supports a prohibition of “balance billing” of a patient provided there is a corresponding fair and independent mechanism to resolve provider-insurer billing disputes.

Patients should also not have to pay any more out-of-pocket costs for emergency care than they would have paid if it was in-network. Under current law, this patient protection only applies to coinsurance and copays for emergency care, not deductibles. In fact, more than half (59 percent) of patients said they wish their insurer provided them with lower deductibles —the amount a patient has to pay before their insurance coverage kicks in. 

Congress is working to prevent patients from getting surprise medical bills. But, if it’s not done right, patients’ access to care could be in jeopardy. Government rate-setting strongly favors insurance companies while creating new barriers that would limit patient access to emergency care.

Independent dispute resolution (IDR) is the strongest federal solution to protect patients from surprise medical bills. A successful approach should include a workable IDR mechanism without a minimum qualifying threshold. 

Emergency physicians work with other medical specialties as part of Out of the Middle, a coalition of nonprofit physician groups united as the voice of hundreds of thousands of physicians dedicated to ensuring that Congress protects patients without letting insurance companies dodge their responsibility to cover care.

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