Trump Calls for Congress to Pass ‘Surprise Medical Bill’ Legislation

Billing Disputes

Surprise bills are a function of how health insurers set up their networks of covered doctors, hospitals and other providers. When medical providers are in insurers’ networks, they generally can’t bill patients for more than a contractually agreed amount. But when clinicians are out of network, as can happen in emergency situations, patients can be left with staggering charges.

The White House also said that disputes between insurers and providers should be resolved through negotiation and that any solution shouldn’t increase federal spending, Joe Grogan, director of the administration’s domestic policy council, said on a call with reporters before Trump spoke.

“The data would seem to indicate that there are a small number of facilities taking advantage of this situation, and taking advantage of patients, and not protecting the economic wellbeing of their patients,” Grogan said. He said 15% of hospitals have more than 80% of the emergency visits that result in surprise bills.

More than half of Americans have received an unexpected medical bill, according to a survey last year by the research group NORC at the University of Chicago. One-fifth of emergency-room admissions triggered a surprise bill, according to a 2017 analysis from economists at the Federal Trade Commission.

Action on surprise medical bills has been mentioned as one of the rare places where Democrats and Republicans can find common ground in Washington. Much of the health care industry agrees in principle that patients shouldn’t have to deal with the disputes between health insurers and medical providers that lead to the bills. But how the details are worked out has huge stakes for the companies involved.

About half the states have some law to limit consumers’ exposure to balance-billing, and nine of those are considered comprehensive protections, according to a Commonwealth Fund report.

— Read Trump Says Balance Billing Efforts Are Coming, on ThinkAdvisor.

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