Consumers are seeking more information from hospitals about the cost of their care and the quality of that care so they can make informed decisions. They also need a similar commitment from insurers, physicians, and other providers. With all parties working together, consumers can navigate the complex care system, armed with sufficient information to make the best choices about their health care.
Surprise Balance Billing
Surprise medical bills may occur when a patient receives care from an out-of-network provider or when his or her health plan fails to pay for covered services provided at an in-network facility.
This issue has received significant federal attention.
At the federal level, H.R. 3630, the No Surprises Act, and S. 1895, the Lower Health Care Costs Act, both contain language intended to protect patients from balance billing, when a patient is billed for the difference between what a provider bills and the insurance company pays. But the legislation defines how providers will be paid—rate-setting—by establishing a benchmark rate, which HAP opposes. HAP has advocated to protect patients from surprise medical bills by prohibiting balance billing and holding patients harmless to in-network cost sharing obligations. HAP urges Congress to protect patients first, and allow providers and insurers to resolve payment disputes without government interference, such as rate-setting.
HAP also is engaged with state policymakers regarding surprise balance billing practices. HAP continues to advocate that any state balance billing proposal be grounded around any federal action on the issue.
Publishing Standard Charges and Negotiated Rates
HAP and other national provider organizations have serious concerns about a new federal proposal calling for hospitals to:
- Post a list of all of their standard
and payor-specific negotiated rates
for all items and
services in a machine-readable format on their websites
- Post payer-specific negotiated rates for all
items and services, and also publish the negotiated rates for 300
"shoppable" services, including 70 defined by the Centers for Medicare & Medicaid Services
Posting standard charges and negotiated rates does not provide consumers with helpful information about out-of-pocket costs. While there are standard charges, there is no standard patient or treatment, and chargemasters alone don’t tell the whole story. In addition to a host of legal and operational concerns, requiring the posting of negotiated rates would likely undermine competition in the private market, and result in increased prices.
Patients are urged to speak directly with their physicians,
insurers, and hospitals to get the most appropriate information about the cost
of care. Many hospitals already have implemented price calculator tools that patients can use, and
all hospitals have billing professionals who can assist patients with individual circumstances.