Surprise Medicals 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.

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. IDR is a simple and efficient solution that incentivizes providers to charge reasonable rates, and insurers to pay appropriate amounts. In New York, this model has almost eliminated surprise bills; furthermore, insurance premiums and health care costs in the state have grown slower than the rest of the nation. Unlike government rate setting, IDR takes into account the increased costs associated with rural health care and ensures rural Americans’ access to health services continue to be protected. In fact, according to a recent poll, a majority of Americans prefer IDR to rate setting. 

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