Balance Billing Laws in Congress Face Opposition

Physician groups are reportedly lobbying against balance billing laws that would do away with surprise medical bills.

Consumer advocates say that these groups are doing their best to shut down surprise medical bill laws in Congress, causing concern that these proposed bills may collapse under the pressure.

“Balance billing” refers to patients being charged for their health care services when their insurance provider doesn’t fully cover the charges from a physician. Patients may also get surprise medical bills if they are expecting in-network coverage rates for a provider but are shocked to receive a bill that their insurance company has barely adjusted due to a provider’s unexpected out-of-network status.

According to the National Academy for State Health Policy (NASHP), seven states have enacted laws which regulate surprise balance billing and protect consumers. Additionally, at least 22 states have introduced bills to establish or strengthen balance billing laws in the state.

Some of these laws prohibit balance billing in special circumstances, help relieve the pressure on consumers when an insurer and provider are disputing a bill, establish reimbursement standards, require clear information on in-network and out-of-network services, and/or create a balance billing resolution process in the state.

Surprise Medical Bills

Consumer advocates and some congressional representatives are doing their best to get national relief passed for surprise medical bills. However, between an alleged million-dollar ad campaign targeting senators and pressure placed on state and national delegates, it is reportedly difficult to accomplish anything in Congress this year.

An anonymous congressional aid told Modern Healthcare that this may be the exact outcome some physician groups are hoping for. The aid said that provider groups “don’t want to see a solution” in order to keep the “status quo” and keep surprise billing “in the mix.”

Shawn Gremminger, senior director of federal relations for Families USA, a consumer advocacy group, agrees that the deadlock in Congress benefits everyone except the consumers facing thousands of dollars in surprise medical bills, like when you see an in-network provider, but your labs were tested by an out-of-network lab.

“Both sides (insurers and providers) are looking at this from a risk-reward perspective of: What makes the most sense?” Gremminger told Modern Healthcare. “For them, doing nothing is the best solution, which pretty much tells you why we’re seeing what we’re seeing, although they won’t publicly say it.”

Despite the allegations being tossed at provider groups, these organizations insist that they are not aiming to do nothing in response to surprise medical bills from balance billing.

“We want to see legislation,” Chip Kahn, CEO of the Federation of American Hospitals, a for-profit hospital group, told Modern Healthcare. “It’s a problem we can’t solve ourselves—I wish we could—and we need legislation to ensure patients don’t suffer from sticker shock, that their copayments are reasonable and within the bounds of their coverage.”

Only time will tell whether or not balance billing laws can successfully make their way through Congress. Until then, consumers may be forced to continue pay thousands of dollars out of pocket to cover surprise medical bills coming from emergency care, anesthesia, imaging, blood tests, and other services.

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This article is not legal advice. It is presented 
for informational purposes only.