Surprise! You Owe Big Bucks!

July 3, 2019

By Jill Zorn |

Even if you are well-insured, you are only one surprise medical bill away from potential financial disaster.

Stories

Horror stories from around the country about surprise medical bills are in the news regularly. Kaiser Health News has a column called “Bill of the Month”. In June they wrote about Liv Cannon of Austin, Texas who received an unexpected bill of $94,031 for “neuromonitoring services” related to the spinal surgery she received. Her other bills for the complex surgery, which amounted to over $100,000, were covered by her insurer. But when it came to this totally outrageous additional bill, the insurer paid only $815.69 and she was expected to pay the balance.

Vox ran a series on emergency room bills, asking readers to send in their bills. One story they featured was about Scott Kohan, who was treated for a broken jaw at an in-network hospital. But, as it turned out, the oral surgeon was out-of-network. In fact, the surgeon does not contract with ANY insurer in the area. The bill came to $7,924.13.

Another story featured in Vox was about a young woman who was in a bicycle accident and broke her arm. She was taken by ambulance to Zuckerberg San Francisco General Hospital where they did several radiology exams, put her arm in a splint and gave her pain killers. Her insurer paid just under $4,000 for the ER visit. The rest of the bill, $20,243.71, was sent to the patient, who was expected to pay it because, at the time, the hospital’s ER had NO contracts with any private insurers.

Polls

Given stories like these, and their own experiences, polls show that Americans are rightfully worried.   This Kaiser Family Foundation Health Tracking poll conducted in April reports that 40% of people had an unexpected medical bill in the past two years (see Figure 13). The Foundation’s own poll showed that 39% of Connecticut adults had received an unexpected medical bill in the previous year. The Kaiser poll shows that, regardless of party affiliation, people want the government to take action to protect patients from surprise medical bills (see figures 10 and 11).

So, what can be done?

States

I’m proud to say that Connecticut is a leader in fighting back against surprise medical bills. Legislation passed initially in 2015, championed by Senate President Marty Looney and Minority Leader Len Fasano, and has been improved over time. In the 2019 session, protections from surprise lab bills were added to the law (see Section 240 of PA 19-117, the 2019 budget implementer bill).

Up until this year, only nine states had passed comprehensive legislation. But the issue is gathering steam. In 2019 alone, five other states either passed new legislation or strengthened existing laws.

Federal Government

As is often the case, the states are leading the way, but federal action is also crucial. While states only have jurisdiction over fully insured plans, most large companies are self-insured, and these plans can only be regulated by the federal government. Over 75% of Connecticut residents who receive their coverage from large employers, work for companies that are self-insured.

Fortunately, addressing surprise medical bills, just like prescription drug affordability, definitely appears to be on the Congressional agenda, and has bipartisan support. Even President Trump is urging Congress to address the issue. In fact, a bill passed by the Senate HELP Committee last week by a vote of 20-3, proposes remedies for surprise medical bills, in addition to tackling prescription drug prices.

The bill requires that insurers pay surprise out-of-network bills at in-network rates. But this approach has providers crying foul. The president of the Federation of American Hospitals, which represents the for-profit hospital industry, complained that the bill, while protecting patients, will have the “unintended” result of promoting “…rate setting (which) will lead to more narrow networks and a precedent of government interference in free market negotiations.” The American Medical Association (AMA) does not like the idea of accepting in-network rates and prefers having an independent arbitrator to resolve payment disputes.

How unusual: insurers and providers fighting over who will make more money, with consumers caught in the middle. So, stay tuned for compromises that benefit industry to the detriment of patients.

Still, if federal legislation passes, it is bound to make at least SOME difference to peoples’ lives. But, at best, surprise billing legislation is a band aid for a health care system that is in the intensive care unit and needs a much more extensive overhaul. That we need it at all is a symptom of just how sick our current “system” is.

P.S.

Do you have an unexpected medical bill that you are unable to resolve? Contact Connecticut’s Office of the Healthcare Advocate at 1.866.466.4446.

 

 

 

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