About one in six times someone is taken to a first aid department or checked in to the hospital, after which the treatment is followed by a medical bill & # 39; surprises & # 39 ;, according to a study released Thursday.
And depending on where you live, the chance can be much greater.
The report from the non-partisan Kaiser Family Foundation notes that millions of people with solid coverage from major employers are nevertheless exposed to & # 39; out-of-network & # 39; costs that can amount to thousands of dollars.
It comes as Congress legislators from both parties and the Trump government is committed to closing the loophole, with a Senate panel scheduled to vote on legislation next week.
In an emergency, a patient can end up in a hospital that is not in his insurer's network. Even in a hospital in the network, emergency doctors or anesthesiologists may not have a contract with the patient's insurer (file image)
The chance that a patient receives a surprise bill varies greatly depending on the state in which he or she lives. Texas seems a bit of a gamble, with 27% of emergency room visits and 38% of hospital stays at least one of these visits triggering Bill. Minnesota looks safer, with a score of 2% and 3% respectively.
Kaiser Foundation researcher Karen Pollitz said the reasons for such major differences are not entirely clear, but seem to be related to the breadth of hospital and doctor networks in every state and the ways in which those networks are designed.
Patients in New York, Florida, New Jersey and Kansas also received surprise bills more often. Other states where it was less likely were South Dakota, Nebraska, Maine, and Mississippi.
On average, 18 percent of emergency room visits and 16 percent of hospital stays resulted in a surprise bill for patients with health insurance through a large employer, the study estimated.
That illustrates the need for Congress to participate, Pollitz said, as plans for large employers are regulated by federal law and surprising billing protections that have already been introduced by states such as New York do not apply to them.
& # 39; This is a prominent problem for patients and it is beyond the scope of state law to fix it, and it is by definition beyond the ability of patients to arrange it themselves, & # 39; she said.
This Wednesday, the Senate College for Health, Education, Labor and Pensions plans to vote on two-party legislation that would limit what patients can pay for their own deductible and transferable rights.
According to Sens. Lamar Alexander, R-Tenn., And Patty Murray, D-Wash., Insurers outside hospitals should pay the median – or midpoint – interest paid to network providers.
The House Energy and Commerce Committee is working on similar legislation. President Donald Trump has said he wants to sign a bill.
Large lobby & # 39; s from the sector take on the fight. Insurers and employers are generally in favor of the Alexander-Murray law approach to paying outside of network providers, using a network rate as a reference point.
But hospitals and doctors want controversial bills instead to request arbitration. New York has an arbitration system and a recent study found that it worked well. However, some legislators fear that this could lead to costly new bureaucracy on a national scale.
Surprise accounts can be created in various ways.
In an emergency, a patient can end up in a hospital that is not in his insurer's network.
Even in a hospital within the network, emergency doctors or anesthesiologists may not have a contract with the patient's insurer.
For a planned operation in a hospital within the network, not all doctors are included in the patient's plan.
Bills can amount to tens of thousands of dollars and affect patients and their families when they are most vulnerable. Patients are often able to negotiate lower rates by collaborating with their insurers and medical care providers. But the process usually takes months, increasing stress and anxiety. If it fails, bills can be sent to collection agencies.
The Kaiser estimates are based on insurance claims from 2017 for nearly 19 million people, or more than 1 in 5 of those covered by large employers. The details of the claims come from an IBM Health Analytics database that contains information provided by plans from major employers. Researchers excluded patients 65 years of age or older, most of whom are covered by Medicare.
The Alexander-Murray legislation also contains other ideas aimed at reducing medical costs by promoting competition with branded drugs, blocking contracting practices in the health sector, setting prices and raising awareness of information. A public health section of the bill would allow a national campaign to raise awareness of the role that vaccines play in preventing diseases.
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