On Tuesday, September 18, 2018 Senators Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO) released draft legislation that aims to protect patients from surprise medical bills. The discussion draft (view the entire draft) of this proposed legislation tackles three main aspects of balanced billing:
- Emergency services provided by an out-of-network provider in an out-of-network facility
- Non-Emergency services following an emergency service from an out-of-network facility
- Non-Emergency services performed by an out-of-network provider at an in-network facility
The discussion draft outlines legislation that would prevent balanced billing of patients for emergency medical services and instead require insurers to pay the difference between out-of-network and in-network costs. This discussion draft was likely fueled, in part, by some recent headlines highlighting extremely high bills received by patients. In his press release, Senator Cassidy references two stories in particular, one of a patient who received a bill of nearly $109,000 for care after a heart attack, and another of a patient who received a bill for $17,850 for a urine test.
The AAA knows that balanced billing is a major issue for our members and will be monitoring this legislation closely. The AAA and member representatives worked with Senator Cassidy on the initial language as it pertained to ground ambulance service providers and suppliers. Our initial analysis of the most recent draft legislation indicates that the language would not apply to ground ambulance service suppliers but there is ambiguity as to whether it could apply to hospital-based providers. The AAA will continue to engage with Senator Cassidy on ground ambulance issues related to the discussion draft. At this point no AAA member action is needed, and we will keep our members informed of any potential issues.
Ambulance services provide an essential, on-demand healthcare benefit to their communities. Unfortunately, our current healthcare payment structure means that much of this care is not compensated equitably, resulting in the necessity of balance billing patients.