Press Releases

Over the past several years, surprise billing has rapidly risen to the top of the list of Americans’ health care concerns, surpassing worries about high premiums, high deductibles, and costly prescription drugs.
 
“Surprise billing, sometimes called balance billing, happens when a patient visits an out-of-network care facility, or even when they are at an in-network facility but are seen by a doctor who is not in their network,” Rep. Tim Walberg, Republican Leader of the Subcommittee on Health, Employment, Labor, and Pensions said in his opening statement at today’s subcommittee hearing on surprise billing. “The story of surprise billing may go something like this: A worker who’s having trouble breathing visits an emergency room at a hospital in his health insurance network. While there, he receives an X-ray of his chest and is seen by a doctor who prescribes medicine to ease the strain on his lungs. Following the visit, he gets a bill – a high bill – for the trip to the emergency room. Even though the hospital was technically in-network, the doctor who saw him was not, leaving him to pay for the cost of the treatment.”
 
Unexpected medical bills cause a significant amount of financial stress for workers and families, many of whom may not have the funds set aside for this unforeseen expense. Patients deserve access to clear and comprehensive information about their health care coverage so that they can avert an unexpected bill.
 
“A key component of surprise balance billing is the ‘surprise’ – that is, the lack of information necessary for patients to make informed decisions about the health care services they receive and from whom,” Ms. Ilyse Schuman, health policy expert from the American Benefits Council, testified. She explained, “[W]here patients seek care at in-network facilities from in-network providers, patients generally lack the information necessary at the time of scheduling to receive care from an in-network ancillary (but necessary) service provider like an anesthesiologist, radiologist, or pathologist. On the day of surgery, is the patient really going to question the network status of the anesthesiologist? Again, the patient is left with effectively no choice at all.”
 
Federal policy solutions to remedy surprise billing should expand patient choice and safeguard employer-sponsored health coverage offered under the Employee Retirement Income Security Act (ERISA). About 110 million individuals receive high-quality insurance through an employer-sponsored plan under ERISA.
 
“ERISA exempts self-insured plans from state insurance regulations to ensure that national employers can offer uniform health benefits to employees residing in different states. Accordingly, the problem of surprise billing cannot be left to the states to solve. Adequately addressing this problem in a way that limits the financial burden on all consumers necessitates a federal solution,” Ms. Schuman testified.