Surprise Medical Bills Act

Sen. Bill Cassidy

Amendments to the bipartisan Surprise Medical Bills Act has some in the medical field crying foul.

The bill’s original focus was the unexpected and often high charges patients faced when they received care from a doctor or hospital that is not in their insurance network. But, authors of the bill have recently turned in a different direction to include specialty medical service charges such as air ambulances.

The move has alarmed Seth Myers, CEO of Air Evac Lifeteam, whose companies have heliports in Rayville and Natchez, Miss. and services northeast Louisiana and east Mississippi.

“(The addition to include specialty medical services in the bill) was an afterthought, so the problem with the way the bill was written is it calls for any transport  that is not in-network with (the patient’s) plan we would pay the median network rate,” Myers said.

Louisiana Senator Bill Cassidy along with other members of a Senate bipartisan working group, introduced the bill May 2019 after a year-long effort of revising proposals and requesting feedback on draft legislation released last September.  

“Patients should be the reason for the care, not an excuse for the bill,” Cassidy said. “We have worked for almost a year with patient groups, doctors, insurers and hospitals to refine this proposal. This is a bipartisan solution ensuring patients are protected and don’t receive surprise bills that are uncapped by anything but a sense of shame.”

Physicians have more insurances companies in-network than specialty medical companies, Myers said. Air Evac Lifeteam has been “working for years to establish in-network agreements” with many insurance companies refusing to negotiate and dropping out after the Affordable Care Act.

“We found certain insurance companies — not all but some — would suddenly drop their rates they would pay us and leave the people who were covered by the plan with a large bill,” he said.

Like many specialty medical company representatives, Myers argues the Senate proposal does not address insurers’ role in the balance billing question.

Balance billing is the foundation of Surprise Medical Bills Act. Balance bill is when a health care provider sends a patient bill charging them whatever the difference is between the price set for a service by the provider and the price the health insurer is willing to pay. 

“The language goes on to say if there is not an in-network rate to go on then it is up to someone in the state to name the rate which is very open-ended,” Myers said.

The Surprise Medical Bills Act originally included what was known as “benchmarking” to set payment amount for out-of-network doctors. Under the original wordage, instead of sending patients a bill for the amount their health plans did not pay, a doctor would be forced to accept an amount average of what other area doctors were paid for the procedure.

If passed, damage could be drastic to specialty medical services, Myers said.

“Over 70 percent of the people we fly don’t pay for the cost of that single transport,” Myers said. 

Seventy percent of the people are made up of medicare, medicaid and those who do not have insurance, Myers said.

“The problem here is medicare is only paying 50 percent of the cost of the flight,” Myers said. “Medicaid is only paying 30 percent of the cost for the flight and those that are uninsured is literally paying only a couple hundred dollars. How do I make up the difference? Healthcare is ‘cost shifting.’ Insurance companies on that last 25 to 28 percent of the people that we fly make up the difference.”

If an insurance company drops down to paying below cost, “I don’t have a cost shift. We are already financially strained as an industry,” Myers said.

This year over 30 bases have closed in rural areas, Myers.

“A bill like this would cause even more loss of rural access,” Myers said. “That is why we are very concerned. Sen. Cassidy has heard our concerns and the unintended consequences of (this bill).”

Originally, the Surprise Medical Bills Act addressed three scenarios in which surprise medical bills would be prohibited.

First, the bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider, Cassidy said.

Secondly, the bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility, Cassidy said.

Thirdly, the bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging service, Cassidy said.

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