Fact Sheet: Patients Should Not Settle for Subpar Patient Protections against Surprise Medical Billing

Patients Should Not Settle for Subpar Patient Protections against Surprise Medical Billing

• A substantial effort is underway by some in the House to include legislation to address surprise medical bills in a year-end package. This attempt is being made during a public health crisis and would benefit insurance companies by stripping nearly $20 billion from providers serving on the front lines of the COVID-19 pandemic. Meanwhile, hospitals, physicians and other providers continue to seek common ground on this important issue.
• Hospitals and health systems are deeply concerned about the effect of unanticipated medical bills on our patients, which could impact their out- of-pocket costs. Protecting patients from surprise medical bills is a top priority for the AHA and all of our members. Equally important to the AHA is patient access to hospital care.
• However, we oppose legislative proposals that set a default payment rate for out-of-network services. While no legislative language has been provided, we understand the proposal would include a prohibition on balance billing and rely on rate setting to establish an initial payment, with an opportunity for providers to dispute the payment.

• Congress should not include in any end-of-the year legislation harmful provisions that rely on an arbitrary government rate, as this would jeopardize patient access to hospital care.

  The latest “solution” would strip $17 billion to $20 billion from providers.

  80% of these “savings” would come from in-network providers — the very providers who cannot surprise bill patients.

• And patients would likely not see a dime. The money would go to insurers, and nothing in the legislation would stop them from adding it to the record profits they’ve amassed during the COVID-19 global pandemic by pocketing patients’ unspent premiums.
• Instead, Congress should protect patients from surprise medical bills while preserving the appropriate role of providers and insurers in negotiating payment rates.