HMA clients who maintain non-participating status with an insurance carrier or a managed care plan will have the most interest in this blog.
Chad Mulvaney, Director, Healthcare Finance Policy for the Healthcare Financial Management Association, posted the following article in the HFMA blog on July 29th. When considering the amount of pressure being placed on Congress over the past two years, this is somewhat surprising. Interestingly, keep in mind that Massachusetts has not adopted any such legislation yet.
Jul 29, 2020
By Chad Mulvany, FHFMA
- It appears Congress will be “unable” to protect patients from surprise medical bills before the election, despite a push from key health committee chairs and the Trump administration, according to a recent Politico article.
- Senate Republicans were expected to unveil a package of rescue measures last week that would skirt contentious health issues but include protections for hospitals from lawsuits over coronavirus exposure and possibly money for Covid-19 testing that private insurers won't cover, according to Politico.
- HFMA’s Chad Mulvany says patients who receive surprise bills likely consider it a negative administrative experience that will make them avoid a given provider in the future, and tell their friends about it too.
Politico is reporting that, “Congress looks unable to protect patients from surprise medical bills before the election, despite a push from key health committee chairs and the Trump administration to include a fix in a new coronavirus relief package. Senate Republicans are expected to unveil a skinny package of rescue measures this week that will largely skirt contentious health issues but include protections for hospitals from lawsuits over coronavirus exposure and possibly money for Covid-19 testing that private insurers won't cover.”
On the one hand, I’m not completely shocked that a surprise bill fix is getting left out of the next COVID-19 relief package. Given the financial losses providers have experienced through the pandemic and their importance to COVID-19 response, particularly ED physicians, it’s not a surprise that Congress is choosing to punt on this fight. However, given that folks on the Hill generally agree legislation is needed to address the issue — they just can’t decide how they want to protect consumers — it’s surprising that Congress isn't taking this opportunity to resolve the issue. Cause if they can’t do it now, when are they going to do it?
Patients who receive a surprise bill will likely consider it a negative administrative experience that will make them avoid a given provider in the future if they can and tell their friends about it too. Frequently, surprise bills result from services received in a hospital but not provided by the hospital or its physicians. These services are delivered and billed for by a provider who has privileges to practice at the hospital but does not (for a variety of reasons) participate in the same health plans as the hospital. However, even though the surprise bill doesn’t come from the hospital (or its employed physicians), patients still associate the negative administrative experience with the hospital.