(Washington, D.C., Wednesday, October 21, 2020) – The COVID-19 crisis exposed how vulnerable patients and their families are to exorbitant out-of-network charges – a profound affordability threat for millions of Americans who are still trying to recover from the health and financial consequences of COVID-19. These charges often come from private equity-backed providers that have built a successful business model based on charging excessive prices that far exceed market rates.
A recent report from the U.S. Department of Health and Human Services provides the strongest call yet for Congress to finally take action on surprise medical bills, calling the practice “a market failure that will not correct itself.”
We ultimately all end up paying the cost of these charges. Research from the USC-Brookings Schaeffer Initiative for Health Policy finds that “eliminating provider leverage stemming from the ability to surprise-bill could reduce commercial insurance premiums by as much as 5.1%, or $212 per member per year.”
The only way for Congress to provide comprehensive surprise billing protections for patients is to pass federal safeguards that target the root cause of this market failure. This includes banning balance billing in situations where patients are involuntarily treated by an out-of-network provider, including when they are seeking emergency care; and, establishing fairly negotiated, market-based payments for out-of-network services so that every consumer benefits from comprehensive surprise billing safeguards.
Tried and true bipartisan solutions are on the table – specifically the surprise billing protections passed by the Senate HELP Committee – that must be included as part of any federal solution.
Members of the Coalition Against Surprise Medical Billing, which represent leading employer groups, 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.
Clare Krusing is a spokesperson for the Coalition Against Surprise Medical Billing and works with patients, unions, employers and health care payers on policies that will make health care more affordable for patients. Clare helps lead the organization’s advocacy work in Washington, DC as they work to pass federal legislation to stop surprise billing across the country.