INDIANAPOLIS – As 2020 comes to end and Congress deliberates on a much-needed additional COVID-19 relief package, the Indiana Hospital Association (IHA) is commending a bipartisan consensus that has emerged in Washington, D.C. to tackle a critical issue—surprise medical billing.
“Surprise medical bills are rarely from hospitals themselves, but they affect our patients,” said Brian Tabor, president of IHA. “While Indiana made an attempt to address surprise billing in the last legislative session, most insurance plans are unfortunately outside the scope of state regulators.”
The “No Surprises Act” was released on Dec. 11 and may be voted on before the end of the year. The legislation prohibits balance billing of patients for medical care the patient reasonably could have expected to be in-network and does not allow patients to be charged more than the in-network cost-sharing amount. The proposal does not rely on a benchmark payment rate to determine out-of-network reimbursement, but instead includes a period for health plans and providers to negotiate reimbursement, to be followed by a mediated dispute resolution process should it be necessary.
“A federal solution is needed, and we ask Indiana’s congressional delegation to act and support the following principles as the ‘No Surprises Act’ is refined,” said Tabor.
Hoosier patients need protection and should be taken out of the middle of disputes between insurance companies and out-of-network providers; Independent physicians must be treated fairly by insurance companies, so a process for resolving these disputes that avoids government price-setting is essential; and Legislation should focus on the core elements of surprise billing and not be bogged down by extraneous provisions.
Just as importantly, another insurance challenge facing many patients in 2020 is the impact of high deductible plans. With Indiana’s new pandemic-related requirement regarding the postponing of certain non-urgent procedures, Hoosiers are concerned that needed medical care may be unaffordable in early 2021 as insurance deductibles “reset”. Many Hoosiers typically seek care in December after meeting their deductibles earlier in the year.
“Indiana’s hospitals are doing everything they can to reschedule patients as soon as possible, but we need insurance companies to assure these patients that they will not face unfair out-of-pocket costs,” said Tabor. “Health insurance companies have fared very well during this health emergency, and we call on them to commit to solutions and take swift action.”