Almost 14% of patients receive a surprise hospital bill

Conversely, these specialties were least likely to be out-of-network: * Oncology: 0.8 percent. * OB-GYN: 1.1 percent. * Urology: 1.2 percent. * Gastroenterology: 1.5 percent. LAWMAKERS

CONSIDER CHANGES Health plan networks have traditionally been regulated by states, not the federal government. But as studies, investigations and word of mouth spread, members of Congress

also have become vocal about surprise billing. Last September, six senators drafted a bipartisan discussion bill to limit the surprise charges to 125 percent of the average amount that

insurers in the area allow for a service in their networks. Additionally, in October, Sen. Maggie Hassan (D-N.H.) introduced the Medical Bills Act of 2018, aimed at using binding arbitration

to determine the allowable charges in surprise bills. These and similar ideas are still under discussion and have not been brought to the floor for votes. Far too many Americans “are faced

with massive, unexpected medical bills for care that they thought was covered in their insurance, and patients who try to follow the rules should not be penalized by disputes between

insurers and providers,” Hassan said in a statement to AARP. In the House of Representatives, a subcommittee under the Education and Labor Committee plans an informational hearing on

surprise bills on Tuesday.    The American Hospital Association argues that the government should not establish fixed payment rates for out-of-network services. Doing so “could undermine

patients’ ability to access in-network clinicians by giving health plans less of an incentive to enlist physicians and facilities to join their networks because they can rely on a default

out-of-network payment rate,” the association said in a statement outlining its position. New York has its own law that requires hospitals to advise patients to check with the physician

arranging their admission about other providers they may encounter, such as an anesthesiologist, in order to determine which health plans they participate in. “It requires physicians to

disclose this information to the patient in advance of the scheduled service,” says Kathleen Shure, senior vice president of health finance and managed care at the Greater New York Hospital

Association. “However, it is frequently not possible to do this in emergency situations, and patients may have no control over who they are treated by.” She says it is important for state

laws “to hold patients harmless in out-of-network emergency situations so that the only costs they are responsible for are any applicable copays or deductibles. New York law does this.” Yet

the New York hospital association says broadening networks is not necessarily the best way to fix the problem.