Frequently Asked Questions
When and why do patients typically receive surprise bills?
In some cases, patients find themselves in situations where they are unable to receive in-network care. Even if they are able to attend an in-network medical facility, some members of their care team (e.g. anesthesiologists, emergency room physicians) may not accept the patient’s medical insurance. In these situations, care providers may bill patients for expenses that cannot be recovered from insurers. This is a pervasive problem: according to a 2018 National Opinion Research Center survey, 57 percent of American adults have received a “surprise bill.”
Will current federal price-fixing (rate-setting) proposals in Congress protect consumers from surprise billing?
Can wider healthcare reforms prevent issues such as surprise billing?
While introducing market reforms can keep surprise billing at bay for millions of patients, a broader array of comprehensive changes is needed to ensure that consumers receive quality medical care at an affordable price. More competition is sorely needed across the healthcare sector as current mandates and regulations protect current insurers against upstart competitors offering simpler plans at a lower price. In addition, certificate-of-need laws prevent hospitals from expanding services and hiring more personnel. Congress should focus on removing barriers to choice and competition and allowing tax-free dollars to be used for the purchase of individual insurance rather than just employer-sponsored plans.
How has government intervention in healthcare impacted surprise billing?
Won’t government price-fixing reduce costs for taxpayers?
The Congressional Budget Office has released estimates of various surprise-billing related proposals and found that price-fixing legislation (i.e. S.1895, the Lower Health Care Costs Act) would increase federal revenues by $26 billion over the next ten years. In turn, this revenue is used in S.1895 to increase spending on a variety of healthcare programs. But as healthcare policy expert Dr. John Goodman points out, the CBO’s estimate is inadequate and fails to account for numerous factors. In fact, it’s likely that price-fixing would create net costs for taxpayers. Dr. Goodman notes, “Because they have less take-home pay, doctors will pay lower taxes [as a result of price-fixing]. And here is the bottom line: doctors are in a higher tax bracket than the average employee. That means that the government revenue gain from taxpaying employees will be offset by an even greater revenue loss from taxpaying doctors.”