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  • Washington Highlights

    President Unveils Surprise Medical Billing Principles

    Len Marquez, Senior Director, Government Relations
    Ally Perleoni, Director, Government Relations

    President Trump May 9 unveiled principles for legislation to protect patients from surprise medical bills at a White House event. A surprise medical bill may occur when a patient has been taken to an emergency room that is out of network; or when a patient is undergoing a procedure that is covered by their insurance, but for which an ancillary provider (e.g., anesthesiologist, radiologist) is out of network. The out-of-network provider then bills the patient the balance of the procedure and associated costs.

    Trump has proposed that the following principles should guide any legislation proposed:

    • Patients receiving emergency care should not be forced to shoulder extra costs billed by a care provider but not covered by their insurer.
    • Patients receiving scheduled care should have information about whether providers are in or out of their network and what costs they may face.
    • Patients should not receive surprise bills from out-of-network providers they did not choose.
    • Federal health care expenditures should not increase.

    The proposal goes further by also stating that in emergency situations, “balance billing for amounts above the in-network allowed amount should be prohibited,” and that, “before scheduling their care, patients should be given information about whether the care providers are out of their network and what related costs that may bring.”

    President Trump also emphasized that any proposal should not increase the cost of health care, and that the patient be protected throughout.

    Congress has not yet released a proposal to address surprise medical bills, though numerous legislators have stated that addressing the issue is a priority. Chairman Frank Pallone (D-N.J.) and Ranking Member Greg Walden (R-Ore.) of the House Energy and Commerce Committee released a statement May 9 reaffirming their commitment to “fixing surprise billing” and stating that, “No family should be left in financial ruin through no fault of their own, which is why we have been working together on a bipartisan solution to protect patients that we hope to announce soon.”

    Following the White House event, Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.) who are leading a bipartisan group of lawmakers in drafting a legislative proposal, stated that they should have a draft soon. “I am pleased that we are all working together across party lines to draft a bill that will help end the absurd practice of surprise medical bills and take the patient out of the middle of these disputes,” Hassan said in a statement.

    The House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions April 2 held a hearing on surprise medical bills, which struck a bipartisan tone [see Washington Highlights, April 5].

    The AAMC was one of six groups that sent a Feb. 20 letter to Congress outlining shared principles for addressing surprise medical bills [see Washington Highlights, Feb. 21].