39 Business Organizations Team Up to Take on Surprise Medical Billing

April 2, 2019

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Kelly Broadway, 202.627.1918, kbroadway@eric.org

For Immediate Release

39 Business Organizations Team Up to Take on Surprise Medical Billing

Washington, DC  – Thirty-nine business organizations sent a letter to the U.S. House of Representatives Education and Labor Committee, Subcommittee on Health, Employment, Labor and Pensions, praising lawmakers for taking up the costly crisis of surprise medical billing, and calling for specific legislative changes to protect patients and end the crisis.

The letter urged Congress to pass legislation that would protect patients from surprise medical bills without undermining network participation or resulting in higher health care costs for all consumers.

The letter made several suggestions on how lawmakers could protect patients by making changes to disclosure and transparency efforts, required reimbursement, and specific countermeasures to end gaming of the system by ambulance companies and emergency department outsourcing firms. Those suggestions, included:

  • Limiting patient cost-sharing to in-network amounts for emergency services performed at an out-of- network facility, or for treatment by out-of-network facility-based physicians performed at in-network facilities
  • Requiring providers who choose to practice at in-network facilities, to accept in-network rates
  • Setting a reasonable federal reimbursement structure that establishes a backstop benchmark rate for emergency services at an out-of-network facility at 125 percent of the Medicare rate
  • Specifying that ambulances and air ambulance services are considered emergency services for purposes of the statutory limitations on balance billing and reimbursement rates.
  • Eliminating problematic incentives in which an in-network facility could profit by allowing or encouraging an outsourced out-of- network emergency department to surprise bill in-network patients

Click here to read the letter in its entirety and for a complete list of participating organizations.