One attendee, Elizabeth Moreno, was overcharged to the tune of $17,850 for a drug test that, without her full knowledge of the tests being performed, were sent to an out-of-network lab that charged an outrageous amount, which some experts have said is far above usual market prices. Stories like Elizabeth's prompted the President, in January, to direct his team to solve this problem and protect the American people. No one should have to bear the burden of surprise medical billing.
Many Americans have had similar frustrating experiences following a trip to the hospital. They thought they understood the care they had received and who provided it only to receive lengthy, unintelligible bills for services they were unaware of by out-of-network providers they never met at prices that far exceed the amounts that insurance pays.
These surprise bills typically result from patients receiving care from an out-of-network provider that they may have reasonably assumed was in-network -- or from receiving out-of-network care in an emergency when they had limited, if any, ability to choose their provider. Think of the time a loved one went to the nearest emergency room in a crisis and was hit with an out-of-network bill. Think of the time you scheduled a surgery after confirming that the surgeon and hospital were in your insurance network, only to be later sent a huge bill for an out-of-network anesthesiologist who you did not choose but who was part of your surgical team.
This is something that could affect any American family in any part of our country. A study published in Health Affairs estimates that in 2014, 14% of outpatient emergency room visits, 20% of hospital admissions through the emergency room and 9% of elective inpatient admissions generated surprise medical bills. Other research indicates that this is not a problem in most hospitals, but is a very large problem at some of them. According to a National Bureau of Economic Research working paper, at 15% of hospitals, more than 80% of emergency room visits produced an out-of-network bill for a patient at an in-network hospital.
This is why the President has called on Congress to act to put American patients first, releasing his principles to end surprise medical billing. There are four main points:
First, patients receiving emergency care should not be forced to shoulder extra costs billed by a care provider that is not covered by their insurer.
Second, patients receiving scheduled care should have clear information about whether providers are in or out of their network and what costs they may face.
Third, no patient should not have to pay surprise bills from out-of-network providers they did not choose.
Fourth, federal healthcare expenditures should not increase.
At its core, more transparency and information can solve much of this problem. Every patient should be informed upfront of the network status of all providers in advance of receiving scheduled care, with a single, comprehensible bill with pricing information about the provider, the services that should be reasonably expected, and the out-of-pocket costs for which they will be responsible. And unless patients provide advance consent, out-of-network providers should not be able to send them bills.
In an emergency care scenario where the patient has no meaningful opportunity to choose the medical facility and providers, patient cost-sharing should be limited to in-network amounts.
In nearly every other consumer market, people expect to be told a price of a good or service upfront so they can make an informed decision about agreeing to pay, negotiating or seeking the good or service elsewhere. The medical system has taken advantage of American patients in some of their most vulnerable moments when they do not have any decision-making power.
President Trump has had enough of this and it is time for these abusive practices end. Unlike Senator Bernie Sanders' Medicare for All legislation that would take away Americans' ability to choose their insurance and eliminate all private coverage, President Trump wants people to be able to keep insurance plans they like while no longer facing the issue of surprise medical bills. The President's solution is practical and focuses on helping real people avoid major, avoidable financial burdens.
Congress should come together on a bipartisan basis to pass legislation, based on these commonsense principles, to end surprise medical billing. It is not acceptable to see hospitals -- institutions ostensibly committed to the mission of patient care -- put patients in these unfair and unnecessary financial situations.
The President is committed to building on what works in our healthcare system and fixing what is broken. And this is just the first installment of larger health pricing transparency efforts to improve the healthcare system through greater choice, competition and innovation. The administration is delivering on its promise to protect American patients and make solution-based changes to healthcare. Now Congress must do its part and deliver legislation to the President's desk that ends surprise medical billing.
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