Groups representing employers give both the White House and Congress accolades for an ongoing joint effort in trying to curb so-called “surprise billing.”
According to Brian Marcotte, president and CEO of the National Business Group on Health, patients should not receive surprise bills from out-of-network providers they did not choose—whether it is for emergency care or for care they receive at in-network hospitals or other in-network facilities.
As Congress and the Trump administration look to address the issue, NBGH, along with other employer associations, have outlined a set of principles that would protect all consumers from higher healthcare costs and would not discourage physicians from participating in networks.
“Healthcare is already complicated and costly enough,” Marcotte says. “Patients shouldn’t be receiving surprise bills from doctors they don’t choose when they go to a hospital in their insurance network or when they have an emergency.”
In addition, NBGH also says hospitals and other facilities should play a central role in protecting patients. For example, hospitals can reduce the likelihood that the physicians they contract with to perform core services (e.g. emergency, anesthesia, radiology, and pathology services) do not charge patients and plans who rely on their in-network status more than what they would pay in-network.
The NBGH reports that employers cover more than 181 million Americans and many already protect their employees and their families from surprise bills, and assist and advocate on behalf of their employees to reduce or eliminate these bills when they happen. Still, surprise bills remain a concern.
NBGH research offers several data points on surprise bills:
- 75% of employers reported that they have protections in place to protect plan participants from balance billing in emergency situations at in-network hospitals and 38% have balance billing protections for non-emergency services at in-network hospitals.
- Emergency room physicians (98%), anesthesiologists (88%), surgeons (67%, pathologists (58%) and radiologists (58%) are the most frequent sources of surprise bills.
- 91% of employers provide assistance to help employees negotiate away or reduce surprise bills, whether it’s HR department staff, their health plan administrator or a health navigator/advocate that the employer contracts with to help.
- 100% of employers have a process for negotiating payment for out of network providers at in-network hospitals. For emergency situations, the most common rate is the average in-network rate for the same services. For non-emergency services, the method to determine the rate is fairly split between a percentage of Medicare, a percentage of UCR (or some other pricing system), with a rate based on average in-network less common.
Steve Wojcik, NBGH’s vice president of public policy, adds that it’s important for HR that employees know that if they have an emergency or they go to a hospital in their insurance network, they won’t be getting extra bills beyond their out-of-pocket cost-sharing.
“The plan protects them from out-of-network charges that they had no control over,” Wojcik says. “It’s also important to HR that employees can rely on a hospital’s in-network designation, that it truly means something.”
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