Administration releases guiding principles for addressing surprise medical bills

The Trump administration said in another healthcare-related announcement that surprise billing is taking an “enormous toll” on millions of families, prompting the White House to release a set of guiding principles for addressing the problem. 

Specific issues that prompted the creation of the new principles, include:

·   A 2018 poll by the Kaiser Family Foundation found that 67 percent of Americans worry about unexpected medical bills, with 38 percent saying they are very worried.

·   Patients are often hit with surprise bills after receiving emergency care from an out-of-network provider, when they could not choose their provider.

·   Patients also often receive surprise bills at highly inflated prices after receiving care from an out-of-network provider they reasonably assumed was in their network.

In response, the administration said the following principles should guide efforts to put an end to surprise billing:

·   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 healthcare expenditures should not increase.

American Hospital Association President and CEO Rick Pollack said in a press statement, “The AHA has urged Congress to enact legislation that would protect patients from surprise bills. We can achieve this by simply banning balance billing. This would protect patients from any bills above their in-network cost-sharing obligations. Untested proposals such as bundling payments would create significant disruption to provider networks and contracting without benefiting patients.”

In February, the AHA said it unveiled its own set of principles to help inform the ongoing federal policy debate regarding surprise billing and joined other hospital groups in sharing a letter with key legislators outlining its position on using the principles as a guide. In a joint letter to congressional leaders in April, the AHA, Federation of America's Hospitals and American Medical Association said, "bundled payments are not appropriate for emergency care and have not been sufficiently tested for widespread adoption for other types of care."