Shaheen & Hassan To Each Introduce Legislation to Combat Escalating Out-of-Pocket Health Care Costs,
Shaheen's bill, the Reducing Costs for Out-of-Network Services Act of 2018, which Hassan is cosponsoring, would cap the amount that hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage. These charge caps would also improve the ability of individual market health insurers to reduce premiums by lowering costs for in-network hospital and physician services. This legislation provides patients in the individual insurance market with similar protections to safeguards that Medicare Advantage beneficiaries have already benefitted from for years. Those Medicare protections have proven successful in holding down in-network health care provider costs in the Medicare market, so expanding similar protections to the individual market could help address rising premiums.
"Far too many Americans know what it's like to receive an exorbitant health care bill and not know how they're going to pay for it. As the Trump administration continues to sabotage the Affordable Care Act, destabilizing the insurance markets and driving up out-of-pocket expenses for families throughout the country, it's imperative that
The bill Hassan will introduce, the No More Surprise Medical Bills Act of 2018, which Shaheen will cosponsor, would help eliminate surprise medical bills for people with employer-sponsored health plans. The bill will protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount. The bill also protects patients in non-emergency situations from surprise bills by requiring hospitals and providers to notify patients if services will be out-of-network and get their consent. Without proper notification and consent, a provider can only charge a patient the in-network amount. If payment disputes arise when these rules aren't followed, the legislation would establish an independent entity to resolve disputes between providers and health insurance plans, without putting patients in the middle. This dispute resolution system is based on a "baseball-style" or "final offer" model, where the provider and insurance plan submit their best and final offer, and the independent entity must choose one of the offers. This model helps incentivize providers and plans to come to a reasonable amount.
"It's unacceptable that consumers are increasingly faced with massive surprise medical bills from care that they thought was in their insurance network," said Hassan. "It's also unfair that consumers get caught in the middle between health care providers and insurance plans haggling over charges. The legislation I will introduce, along with
The Reducing Costs for Out-of-Network Services Act is endorsed by the
"Egregiously high out-of-network bills put a substantial financial burden on consumers who want, need and deserve affordable access to care," said
"We hear about it all the time - astronomical out-of-network charges that bankrupt families - and it's unacceptable," said
The Reducing Costs for Out-of-Network Services Act would do the following:
* Significantly reduce out-of-pocket costs for patients who have individual market health insurance and receive care from out-of-network hospitals and physicians.
* Substantially reduce out-of-pocket costs for uninsured patients who could otherwise be charged very high "full charge" prices for hospital and physician services.
* Reduce premiums for individual market health plans by improving individual market insurers' ability to hold down negotiated provider payments and costs for in-network care. Senators Shaheen and Hassan have led efforts in the