Four things to know:
1. Surprise medical bills due to balance billing, where a patient is on the hook for the difference between the provider’s charge and the insurer’s allowable amount, can occur when a patient receives care at an out-of-network hospital or from an out-of-network provider at an in-network facility. A recent Kaiser Family Foundation poll of 1,201 U.S. adults found that two-thirds of respondents are either “very worried” (38 percent) or “somewhat worried” (29 percent) about being able to afford surprise medical bills for themselves or their family.
2. Experts contend one option that might address the problem is change to federal law. The Employee Retirement Income Security Act of 1974, an existing federal law, regulates company and union self-funded health plans but does not prohibit surprise medical bills, according to the report. Therefore, KHN reported, federal law imposing restrictions applicable to state-regulated policies sold by insurers and federally regulated, employer-sponsored self-funded health plans could help address balance billing.
3. Additionally, the ACA established some consumer protections for emergency services, but does not ban out-of-network emergency physicians, hospitals and other providers, such as ambulance services, from balance billing, according to the report. KHN reported future federal law could ban balance billing for emergency services. Future federal law could also ban balance billing in nonemergency situations.
4. Outside of changing federal law, KHN reported these other options that might address balance billing:
- The federal government could clarify that states can regulate provider payment. It could also require self-funded plans to take part in state dispute-resolution programs.
- States could take action, including putting a cap on how much providers can charge for out-of-network care, or implement state balance billing laws that apply to self-funded health plans.
Read the full report here.
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