Surprise medical balance bills – charges for unexpected, out-of-network medical care – affect thousands of consumers each year. These bills can leave consumers stuck with hundreds, if not thousands, of dollars in unexpected medical expenses.
States are taking the lead in cracking down on surprise balance bills, passing consumer protection laws that range from strict requirements for network service disclosures to outright bans on balance billing in certain circumstances. These resources highlight state and recent federal initiatives to address surprise medical balance billing:
- NASHP Blog and Chart: States Lead on Surprise Medical Billing Protections, Congress Poised to Follow, April 9, 2019. This blog and chart summarize three bills proposed in the US Senate to provide federal protection to curb surprise balance bills, and how they would impact states.
- NASHP Blog and Chart: More States Implement Surprise Medical Billing Protections, June 18, 2019. Four new states have enact multi-pronged policies to prohibit balance bills, institute a process for providers and carriers to resolve billing disputes, and foster pricing transparency to avoid surprise bills. A chart shows these legislative highlights.
- Chart: Highlights of States’ Surprise Medical Balance Billing Laws, March 18, 2019. This chart provides a side-by-side comparison of states that have taken comprehensive approaches to address surprise balance bills.
- Blog: State Legislators Take Action to Protect Consumers from Surprise Billing, Sept. 18, 2018. Summary of state laws enacted in 2018 to address surprise balance bills.
- Chart: Surprise Billing Legislation Passed in 2016, July 20, 2016. This chart summarizes state laws enacted in 2016 to address surprise balance bills.
- Research Brief: Answering the Thousand-Dollar Debt Question: An Update on State Legislative Activity to Address Surprise Balance Billing, April 11, 2016. This issue brief describes the rise of surprise medical balance bills and state and federal efforts to curtail the practice in their states.
As the newly insured use their coverage, increased scrutiny is being drawn toward the experiences of consumers who are receiving care. One issue of growing concern is the accumulation of medical debt, even among the insured. According to a recent study from the Kaiser Family Foundation, more than a quarter of adults in the United States report that, within the past year, they or someone in their household have had issues with medical debt. This includes 20 percent of individuals under the age of 65 who have insurance. Also striking, 51 percent of insured individuals noting medical debt report owing sums of over $5,000, a significant sum for many households.
The issue is especially complicated as recent fluxes in the health care industry triggered by growth and shifts in coverage are occurring in tandem with experimentation by providers and insurers to reduce costs. As the industry stabilizes, it is yet to be seen what methods of controlling costs may prove most effective at lowering those costs and improving affordability for consumers.
One factor under scrutiny is the occurrence of balance or “surprise” billing which happens when patients receive a higher than expected bill from providers, even after factoring for the amount paid by a consumer’s insurer to the provider. States are also taking action to examine the issue, managing the interests of carriers, providers, and consumers to address them. This brief examines this issue, as well as state actions and legislation currently in the queue.