A nonprofit publication of the Kentucky Center for Public Service Journalism

Congress considering legislation that would stop surprise out-of-network medical billing charges

By Nadia Ramlagan
Public News Service

Congress is considering legislation to stop surprise medical bills. According to the Kaiser Family Foundation, in 2017, 7% of Kentuckians received at least one out-of-network medical charge.

Katy Spangler with the Coalition Against Surprise Medical Billing said the Lower Health Care Costs Act would help protect consumers. Several years ago, when she was having her first child, she discovered how just one medical event could result in a charge running into the tens of thousands of dollars.

According to the Kaiser Family Foundation, around 7% of Kentuckians received at least one out-of-network medical charge in 2017. (Photo from Adobe Stock, via PNS)

“I was able to pick my physician, make sure that my physician was in-network. I was able to pick my hospital, make sure that they were in-network. But, I didn’t need the anesthesiologist until I was in a gown, ready to go and have my baby,” Spangler said. “There was no way for me to pick and make sure that my anesthesiologist was in-network.”

Spangler said a scenario like this typically generates a surprise medical bill. The Lower Health Care Costs Act, introduced this summer by Republican Sen. Lamar Alexander of Tennessee and others, would establish a benchmark for medical billing based on region.

Spangler said federal legislation needs to be passed so people don’t get saddled with monstrous bills simply because they had an emergency and were unable to select an in-network provider.

“But where it gets a lot trickier, there are these providers that you don’t pick,” she explained. “And the problem has really been exacerbated because of this market failure. Those providers can charge really high rates – many, many many multiples of the Medicare program.”

Some physicians groups opposing the legislation say the bill could have unintended consequences.

Spangler said some private equity-backed or hedge fund-owned physician staffing companies are purposefully going out of network in order to raise rates.

“So one of the companies that does this, called EmCare, before they went into an area, the amount that was paid for an ER visit was $467. After EmCare came in, they increased that price to $1,649,” Spangler said.

Members of the House Energy and Commerce Committee are now investigating the role of private equity firms in driving up costs that result in surprise medical bills.

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