No Surprises: People Against Unfair Medical Bills

Washington, DC
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Surprise medical bills— also known as surprise out-of-network “balance bills”— are a particularly egregious health care cost, as they are unpredictable for families and occur despite every effort consumers make to avoid them. Surprise medical bills occur when people are charged for care from out-of-network providers or facilities that they receive due to no fault of their own. These bills can amount to hundreds, thousands, and even tens-of-thousands of dollars.

Surprise medical bills are incredibly common. One-in-five emergency department visits result in a surprise medical bill and nearly 70 percent of air ambulance patient transports are out-of-network. These surprise bills are the result of a systemic problem that places families in the middle of a tug-of-war between health care providers and insurers over the price of services.

As consumers, patients, and workers, we call on Congress to enact legislation to ban surprise medical billing immediately. We urge Congress to ensure that such legislation comprehensively protects consumers while holding health care costs down.

Three Key Principles for Surprise Medical Bill Legislation


Principle One: Ban Surprise Balance Billing and Fully Protect Consumers

●       In emergencies and at in-network facilities, balance billing should be completely prohibited

●       Consumers must be protected from surprise billing across health care settings and provider types, including air and ground emergency transport.

●       For out-of-network care that individuals incur due to no fault of their own, they should pay no more than in-network cost-sharing (including copayments, co-insurance, and deductibles)

●       Out-of-pocket spending should count towards a consumer’s in-network out-of-pocket maximum and deductible.

Principle Two: Contain Total Costs for Consumers

●       To ensure that overall premiums aren’t unfairly increased, a reasonable payment level for surprise bills must be established.

●       A reasonable payment level should be based on actual prices being paid in the market, and not be inflationary (e.g., should not be based on billed charges, which almost always do not accurately reflect price).

Principle Three: Ensure Comprehensive Protection Nationwide

●       Federal law should apply to surprise bill situations unless state law is equally or more robust in terms of consumer protections.  Federal law should determine the payment level owed by a plan to a provider in a surprise bill situation except when a state law already established a payment level prior to passage of federal law.

●       Even if states have robust surprise billing laws, federal law should apply to any health plans that states cannot fully regulate, such as self-insured, ERISA-regulated plans and billing related to air ambulances.

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