A bipartisan Senate group released draft legislation Tuesday to thwart “surprise” medical bills that shock patients who seek emergency care at the nearest facility or carefully select a hospital, only to confront an out-of-network doctor who bills them a ton.
Their discussion draft says patients who seek emergency care at an out-of-network hospital shouldn’t be forced to pay more than what they’d normally pay out of pocket under their health care plan.
Senators want to avoid the type of situation faced by Drew Calver, a Texas teacher who made headlines when an out-of-network hospital treated him for a heart attack sent him a $109,000 charge, or “balance bill” reflecting the difference between what the hospital demands and what a health plan is willing to pay.
“Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame,” said Sen. Bill Cassidy, Louisiana Republican spearheading the discussion.
The draft bill says patients who receive out-of-network treatment for an emergency, yet need follow-up care, should receive a written notice that says they might pay less if they transfer to an in-network facility.
And patients who go to an in-network hospital, yet receive care from an anesthesiologist or other provider who loops in from outside their network, would not be required to pay an extra amount under the draft bill.
Any extra charges would be picked up by the patient’s insurer, instead, though the legislation proposes limits on those changes.
The bill also requires the Health and Human Services Department to examine surprise billing problem and make recommendations to Congress.
“No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency,” said Sen. Tom Carper, Delaware Democrat.
Democratic senators Michael Bennet of Colorado and Claire McCaskill of Missouri and Republican senators Charles E. Grassley of Iowa and Todd Young of Indiana round out the working group.