Home » Health » Billing the balance: what it is and why Trump wants to get rid of it

Billing the balance: what it is and why Trump wants to get rid of it

Congress should pass legislation to prevent Americans from receiving surprise medical bills, President Donald Trump said Thursday, adding momentum to a bipartisan problem that has aroused the ire of patients across the country.

According to a survey, more than half of Americans say they received a surprise bill after receiving care. Sometimes called balance invoices, they arrive when a doctor, a laboratory analysis service or a hospital charges more than a health insurer is willing to pay. For patients, it can mean adding unexpected financial problems to a medical problem that is already distressing.

"Nobody in the United States should be bankrupted unexpectedly for health care costs that are absolutely out of control," Trump said in the White House, while along with lawmakers, doctors and patients who have received unexpected medical bills. "No family should be surprised by scandalous medical bills."

Senator Lamar Alexander, the Tennessee Republican who chairs the Senate Committee on Health, Education, Work and Pensions, told Trump during a press conference that he hopes to send a bill to the president in July.

Among the principles that the White House supports: patients should not receive separate bills for off-network charges that they did not accept; emergency care should not generate surprise bills from out-of-network providers, and patients should obtain an initial calculation of costs before receiving scheduled care.

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Trump said the administration is working on a larger transparency effort in health care that he will talk about in the coming weeks.

The Trump administration wants Congress to resolve the details of the surprise billing effort and Trump did not specifically endorse any existing legislation. A bipartisan group of senators, including Alexander, Bill Cassidy, a Republican from Louisiana, and Maggie Hassan, a Democrat from New Hampshire, have been working on the issue.

Billing disputes

Surprise bills are a function of how health insurers configure their networks of doctors, hospitals and other covered providers. When medical providers are in the networks of insurers, they generally can not bill patients more than an agreed amount per contract. But when doctors are out of the network, as can happen in emergency situations, patients can be left with amazing charges.

The White House also said that disputes between insurers and suppliers should be resolved through negotiation and that any solution should not increase federal spending, said Joe Grogan, director of the administration's internal policy council, in a call with reporters before Trump will speak.

"The data seem to indicate that there are a small number of facilities that take advantage of this situation, take advantage of patients and do not protect the economic well-being of their patients," said Grogan. He said that 15% of hospitals have more than 80% of emergency visits that result in surprise bills.

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

Read more: mysterious $ 1,000 lab bills leave patients bewildered and annoyed

The action on medical bills by surprise has been mentioned as one of the few places where Democrats and Republicans can find common ground in Washington. Much of the health care industry agrees, in principle, that patients should not have to deal with disputes between health insurers and the medical providers that carry the bills. But the way in which the details are resolved is of great interest to the companies involved.

About half of the states have a law to limit consumer exposure to balance billing, and nine of them are considered comprehensive protections, according to a Commonwealth Fund report.


Source: http://fortune.com/2019/05/09/what-is-balance-billing/

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