At a news conference last week, President Trump joined the bipartisan chorus calling for a national fix for the aggravating and costly nuisance of surprise medical bills. The principles the president laid out to protect consumers, while vague, point in the right direction, which is to say they would require the industry to take responsibility for solving most of the problem. Unfortunately, some of the ideas under consideration in Congress would go in the wrong direction. It is important to get this policy right for the precedents that will be set for the future.
There are two types of typical surprise billing scenarios. The first occurs when there is an emergency and one or more of the key billing parties — the ambulance, the hospital emergency room (ER), or the ER physician — is outside of the network of the patient's insurance plan. The second is when a patient selects an in-network physician and hospital for a planned service, such as surgery, but the care he or she receives includes ancillary providers (such as anesthesiologists or radiologists) who are out-of-network. In many states, out-of-network providers are not bound by any limits on what they can charge patients. It is easier to solve surprise billing for ancillary providers than for emergency care.
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