Jennifer Finney Boylan, a professor of English at Barnard College and a contributing opinion writer for the New York Times, had been told her child's hospitals stay had been pre-approved and would only cost her a small co-payment—but instead, Boylan ended up with a $145,000 surprise bill.
Boylan's $145K bill
Boylan and her wife had scheduled a procedure for their child months ahead of time. "We'd consulted with the provider, who, indeed, was out of network, but our doctors had assured us that the total cost would nevertheless require nothing but a modest co-payment," Boylan writes.
Instead, Boylan received a bill for $145,000. "I went to bed that night not knowing whether we would have to declare bankruptcy in the morning," Boylan writes.
The day after she received the bill, Boylan contacted her child's doctor, who told her not to worry about the bill.
According to Boylan, another doctor in the same practice informed her that "even when procedures are pre-authorized (as [her] child's was) insurers often deny them anyway. His understanding was that insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up."
But Boylan and her child's doctors did not give up. Ultimately, Boylan writes, "The bill was fixed, and our family is not, as I feared, wiped out."
What's being done about surprise medical bills?
But for many Americans, surprise bills remain an issue, and not all of them are resolved, Boylan writes. About 20% of people who undergo elective surgery in the United States end up with a surprise medical bill, Boylan writes. While Congress has been working on a way to address these bills, they have yet to come to an agreement on a clear fix.
Last week, the House Education and Labor Committee voted 32-13 to advance a bill, called the Ban Surprise Billing Act, to the full House. The bill aims to address surprise medical bills by prohibiting out-of-network providers from balance billing patients in certain instances, including during emergency care. The bill also would establish a benchmark payment rate for out-of-network care that is based on the median in-network payment rate in a given market and calls for establishing an arbitration process that insurers and providers could use to settle disputes over out-of-network payments totaling more than $750.
Separately, the House Ways and Means Committee last week voted unanimously to advance its own measure to address surprise bills to the full House. The House Ways and Means Committee's bill, called the Consumer Protections Against Surprise Medical Bills Act, also would prohibit providers from balance billing patients in certain cases and establish an arbitration process for insurers and providers to resolve billing disputes—but it would not set benchmark payment rates for out-of-network care. Under the bill, providers and insurers would have up to 30 days to negotiate a payment rate for out-of-network charges. If the parties cannot agree on a payment rate during that period, they then could choose to enter an arbitration process established by HHS and the Departments of Labor and the Treasury.
It's unclear, though, whether either of the House committees' proposals—or a third compromise proposal from the House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions Committee—will move forward.
The Trump administration has expressed concerns "that a push to overuse arbitration will raise health care costs," according to spokesperson Judd Deere, and it's unclear whether any legislation that passes the House would gain traction in the Senate. So far, Senate Majority Leader Mitch McConnell (R-Ky.) has not committed to supporting any of the bills.
But a solution to the problem is needed, Boylan writes. "It would be nice if the members of Congress … came to understand that there are worse things in the world than making people's lives better," she writes (Boylan, New York Times, 2/19).