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Senate Health Committee Votes to Reduce Health Care Costs


Before heading off for the Fourth of July holiday, the Senate Health, Education, Labor and Pensions Committee approved legislation that ends surprise billing, creates more transparency and increases competition to reduce prescription drug costs. The bill, known as the “Lower Health Care Costs Act” was approved in a 20-3 vote.

“Altogether, this legislation will help to lower the cost of health care, which has become a tax on family Budgets and on businesses, on federal and state governments,” said Committee Chairman Lamar Alexander (R-Tenn.). 

“A recent Gallup poll found that the cost of health care was the biggest financial problem facing American families. And last July, this committee heard from Dr. Brent James, from the National Academies, who testified that up to half of what the American people spend on health care may be unnecessary.”

Additional information may be viewed on the Committee’s website accessible here: www.help.senate.gov

 

Unforeseen Out-of-Network Charges Cause Concern Amongst Consumers 


About 1 in 6 Americans were surprised by a medical bill after treatment in a hospital in 2017 despite having insurance, according to a study published in June. On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation. Its study was based on large employer insurance claims.  

The research also found that when a patient is admitted to the hospital from the emergency room, there’s a higher likelihood of an out-of-network charge. As many as 26% of admissions from the emergency room resulted in a surprise medical bill. “Millions of emergency visits and hospital stays left people with large employer coverage at risk of a surprise bill in 2017,” the authors wrote. 

The researchers got their data by analyzing large-employer claims from IBM’s MarketScan Research Databases, which include claims for almost 19 million individuals. Surprise medical bills are top of mind for American patients, with 38% reporting they were “very worried” about unexpected medical bills. Surprise bills don’t just come from the emergency room.  

Often, patients will pick an in-network facility and see a provider who works there but isn’t employed by the hospital. These doctors, from outside staffing firms, can charge out-of-network prices. “It’s kind of a built-in problem,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation and an author of the study. She said most private health insurance plans are built on networks, where patients get the highest value for choosing a doctor in the network. But patients often don’t know whether they are being treated by an out-of-network doctor while in a hospital. 

“By definition, there are these circumstances where they cannot choose their provider, whether it’s an emergency or it’s [a doctor] who gets brought in and they don’t even meet them face-to-face.” The issue is ripe for a federal solution. Some states have surprise-bill protections in place, but those laws don’t apply to most large-employer plans because the federal government regulates them.  

“New York and California have very high rates of surprise bills even though they have some of the strongest state statutes,” Pollitz said. “These data show why federal legislation would matter.” Consumers in Texas, New York, Florida, New Jersey and Kansas were the most likely to see a surprise bill, while people in Minnesota, South Dakota, Nebraska, Maine and Mississippi saw fewer, according to the study. Legislative solutions are being discussed in the White House and Congress.  

 

What Keeps You Up at Night?

The cost of healthcare in the United States is a significant source of apprehension and fear for millions of Americans, according to a new national survey conducted by West Health and Gallup. With over $3.5 trillion—nearly one-fifth of the nation’s gross domestic product — spent in 2017 alone, the national poll indicates this financial burden causes a multitude of worries and anxieties for a large segment of American adults.

These findings were published in a report titled “The U.S. Healthcare Cost Crisis,” based on a nationally representative survey of more than 3,500 American adults on the impact of the high cost of healthcare on personal finances, individual healthcare choices and the level of satisfaction with the U.S. healthcare system.

Relative to the quality of the care they receive, the study revealed that Americans overwhelmingly agree they pay too much, receive too little, and have little confidence that elected officials can solve the problem.  Americans in large numbers are borrowing money, skipping treatments and cutting back on household expenses because of high costs, and a large percentage fear a major health event could bankrupt them. 

More than three-quarters of Americans are also concerned that high healthcare costs could cause significant and lasting damage to the U.S. economy.  Despite the financial burden and fears caused by high healthcare costs, partisan filters lead to divergent views of the healthcare system at large: By a wide margin, more Republicans than Democrats consider the quality of care in the U.S. to be the best or among the best in the world — all while the U.S. significantly outspends other advanced economies on healthcare with dismal outcomes on basic health indicators such as infant mortality and heart attack mortality.

Republicans and Democrats are about as likely to resort to drastic measures, from deferring care to cutting back on other expenses including groceries, clothing, and gas and electricity. And many do not see the situation improving.  In fact, most believe costs will only increase. When given the choice between a freeze in healthcare costs for the next five years or a 10% increase in household income, 61% of Americans report that their preference is a freeze in costs.  Other key survey findings include:

77% of Americans are concerned rising costs will significantly damage the U.S. economy.

76% expect their costs for healthcare will increase even further in the next two years.

15 million Americans have deferred purchasing prescription drugs in the past year due to cost.

Nearly 3 million borrowed $10,000 or more to pay for healthcare in the past year.

Only about one-third report that doctors discuss costs with them in advance of procedures, tests or treatment plans, or for medicine required to treat their conditions.

The New York Times published an article titled, “Americans Borrowed $88 Billion to Pay for Health Care Last Year, Survey Finds,” that provides an in-depth analysis of the survey. In the piece, reporter Karen Zraick notes that West Health and Gallup will conduct similar studies going forward.

Balance it Out

  • June 27, 2019
  • Published in Billing

Working with consumers to explain and help resolve medical bills in collections is a complex process for accounts receivable management companies and their health care provider clients.  Add in the mix unexpected out-of-network charges on a consumer’s bill and all parties involved face challenges to find a solution.

State legislatures started to tackle the issue, known as balance billing, to prevent these charges from reaching the consumer after their bill is processed by a provider and insurance company. Bipartisan debate continues at the federal level to enact laws prohibiting balance billing.

A ‘balance bill’ is a term that refers to any time a consumer’s insurance pays part of the bill, yet they are responsible for paying the balance; and states with laws on balance billing indicate the circumstances when it is legal, according to The Commonwealth Fund.

Educate and Work Together

As lawmakers focus on the issue of balance billing at the state and federal level, it’s best for collection agencies in business partnerships with health care providers to learn together with the goal to help patients through the process.

In California, an amendment to the state’s health and safety code (added sections 1371.30, 1371.31 and 1371.9) AB 72, authored by Assemblyman Rob Bonta, D-Alameda, took effect July 1, 2017.  AB 72 applies to non-emergency care that is provided at an in-network facility but performed by a physician who is out-of-network with the patient’s insurance plan.

“The obvious problem that this has created is that it is difficult for the provider to know if the patient was in-network at the facility or if the services were part of some non-emergency treatment that would require AB 72 to be applied,” according to Courtney Reynaud, president of Creditors Bureau USA in Fresno, California, which works in medical collections.

Reynaud, who is also president of the California Association of Collectors Inc., said after the legislation took effect some provider clients stopped referring accounts to collection with charges that could potentially fall under AB 72.  Oftentimes, they had no mechanism to determine if the services were emergency or non-emergency and if the services were provided at an in-network facility.

Reynaud recommends staying informed on legislative issues and compliance through state and national medical associations such as the California Medical Association and Medical Group Management Association. Balancing Compliance California’s legislation is different than laws in other states and proposed bills at the federal level in that it doesn’t cover charges as a result of a patient’s emergency services.

For example, in Florida, legislation in effect since July 2016 protects patients from out-of-network charges at an in-network facility in emergency situations.  Before the legislation took effect, Matt Kiefer, chief officer of information, compliance and development at The Preferred Group of Tampa in Tampa, Florida, said his agency received medical accounts from unexpected charges due to balance billing.

“Covered charges, noncovered charges, coupled with high deductibles and copays can not only be confusing, but upsetting and only exacerbates the issue when out of network charges and balance billing

are allowed,” Kiefer said. “Legislation like HB 221 in Florida to prevent surprise charges helps the patient in an already uncomfortable position.”

If there is pending legislation in your state, or to stay informed about the topic at the federal level, Reynaud also suggests hosting a webinar for clients or coordinate office training for your provider client’s staff.  “The bottom line is to continue to train collectors to be empathetic when working with consumers with medical debt, especially when it comes to medical debt from surprise medical bills if there is not legislation in your state and the charges are from out-of-network providers.”

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