Sens. Jeanne Shaheen and Maggie Hassan: Protecting consumers from exorbitant – often surprise – out-of-pocket health care costs

Imagine opening the mail to find a massive, unexpected medical bill that throws your entire budget into disarray, like the man from Concord who sought treatment for a cut to his finger and was charged $3,500. He was unaware that he was seen by a physician who wasn’t covered under his insurance which resulted in a much higher fee. Or the man from Texas who had a heart attack, was sent to an out-of-network hospital, and charged $108,951 in out-of-pocket costs for care.

Or maybe you don’t have to imagine, because you or a loved one has already experienced such an unfair situation. The fact is, Americans of all walks of life – even those who have insurance coverage – are often terrified to open bills from health care providers. And as out-of-pocket health care costs continue to rise, this problem is only getting worse.

Congress must act to reduce increasing costs and help ensure that every Granite Stater and American has access to the quality, affordable health care that they need to live productive lives.

Recently, we introduced two pieces of legislation that would work in tandem to combat escalating out-of-pocket health care costs, stabilize the health care marketplace, and end the surprise medical bills that so often devastate family budgets.

The first bill, the Reducing Costs for Out-of-Network Services Act of 2018, would combat escalating out-of-pocket health care costs for uninsured patients and for patients who purchase health care on the individual market by capping the amount that uninsured and out-of-network patients can be charged by hospitals and physicians. By limiting these large fees for treatment, this legislation could also help reduce the cost of insurance premiums.

In addition, we’ve introduced the No More Surprise Medical Bills Act of 2018 – legislation that would tackle a related problem: surprise medical bills, where patients receive large, unexpected medical bills, often for receiving care that they didn’t realize was considered out-of-network.

The bill would help eliminate surprise medical bills for people with employer-sponsored health care in two key ways.

In cases of emergency, the bill would prohibit hospitals and providers from charging patients more than in-network services – meaning that no matter where a patient is treated for an emergency, patients won’t be charged exorbitant fees for lifesaving care.

The bill also protects patients in non-emergency situations from surprise bills by requiring hospitals and providers to notify patients if services will be out-of-network and get their consent. Without proper notification and consent, a provider can only charge a patient the in-network amount.

If payment disputes arise when these rules aren’t followed, the legislation establishes an independent entity to resolve disputes between providers and health insurance plans. This system would also ensure that providers and plans are incentivized to come to an agreement over a reasonable fee.

No American should have to sacrifice their financial security in order to stay healthy or receive lifesaving care. But continued failure to address surprise medical bills or control skyrocketing out-of-pocket health care costs, are forcing patients into untenable situations.

The legislation we have introduced would be common-sense steps forward to provide consumers with more certainty and reduce rising health care costs. We will continue working with anyone who is serious about finding solutions to improve our health care system and ensure that Granite Staters and all Americans can receive the affordable care that they need.

(Jeanne Shaheen and Maggie Hassan represent New Hampshire in the U.S. Senate.)