Surprise Billing

When you’re sick, you should be able to focus on what matters most: getting better. Unfortunately, far too often American families have to worry about what happens after they leave the hospital – and whether they’ll receive a surprise medical bill.

Today, too many hardworking Americans are still receiving surprise medical bills. Nearly 1 in 5 Americans can expect to receive a surprise medical bill at some point in their lives. 18% of all emergency visits and 16% of in-network hospital stays result in a surprise medical bill.

Surprise medical bills happen when patients are treated by an out-of-network doctor without knowing it.

Health insurance providers work hard to protect Americans from surprise medical bills and high health care costs – they’re patients’ bargaining power.

Ways to end surprise billing:

  • Protect patients by prohibiting doctors and hospitals from sending surprise medical bills. This takes American families out of the middle and ensures they don’t have to worry about a broken bone that breaks the bank.

  • Require hospitals to tell patients if a physician is out-of-network. Patients have the right to know about their health care. Whenever possible, hospitals should provide full information about any facilities or physicians that aren’t in-network.

  • Establish a fair, reasonable benchmark based on local, market-based rates for out-of-network services. Health insurance providers should be required to pay out-of-network doctors based on local, competitively negotiated rates that their in-network peers already accept.

  • Avoid costly, bureaucratic arbitration. Health care shouldn’t be complicated – but arbitration adds a whole other layer of red tape. Arbitration would require health insurance providers and physicians to engage in a costly, unpredictable, and complex process that will most likely result in higher premiums. It could also mean bad-actor physicians price their services even higher in the hopes of getting a bigger windfall from an arbitration process.

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