Solving the Surprise Medical Billing Crisis

81% of employers responding to our survey stated that surprise billing is an important issue their human resources are dealing with.

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January 13, 2020

Capitol Hill Briefing // September 5, 2019
Remarks of Steve Wojcik
Vice President, Public Policy
National Business Group on Health

Thank you for the opportunity to speak on the employer perspective on this important issue. The Business Group is an association of over 425 large employers focused on improving health care and health benefits.

Employers cover 181 million Americans, of which 110 million are covered by self-insured plans.

Surprise billing is a growing problem for employees and employers. We recently did a quick poll of our members and though it’s a small survey, the data show that:

  • 81% of employers responding stated that surprise billing is an important issue their human resources are dealing with.
  • As with people in other plans, employer plans identified the same types of facility-based physicians driving the problem:  emergency care (96%), anesthesia (88%), radiology (58%) and pathology (58%). These are generally physicians that people do not select, but rather hospitals contract with to provide these services at their facilities.
  • 75% of employers responding report that at least some of their health plan contracts protect employees and their families from balance billing at in-network facilities.
  • 91% of employers provide some type of assistance to employees and their families to deal with surprise medical bills. Some offer multiple means of assistance.  47% of employers responding say that their human resources staff gets involved in advocating for adjudication of claims, 47% connect their employees to their health plan for assistance, 40% connect them to a third party vendor that the employer has contracted with to deal with claims issues, and 5% offer other support, which is primarily negotiating directly with the providers, while only 9% responded that they offer no assistance other than directing their employees to follow the appeals process.

These are stopgap solutions to a growing problem facing employees and employer plans.  We need federal legislation that:

  • Protects patients and families from surprise medical bills sent by out-of-network providers.
  • Maintains fair and equitable payments for providers with a local benchmark standard that does not undermine network participation.
  • Employer plans rely on provider networks for quality and performance standards and to keep coverage affordable for participants. Even consumer-directed high-deductible plans have provider networks overlaying them that protect quality and reduce out-of-pocket costs for employees and their families.
  • Does not add inflationary pressure to health insurance premiums and taxpayers’ costs by avoiding an arbitration process that adds unnecessary cost, delay and bureaucracy to the health system and is particularly harmful for smaller businesses.

 

Coalition Against Surprise Medical Billing Press Release on Capitol Hill Briefing

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