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"upstart" writes:

The bipartisan plan to end surprise ER bills, explained:

The policy proposal, which you can read here, essentially bars out-of-network doctors from billing patients directly for their care. Instead, they would have to seek payment from the insurance plan. This would mean that in the cases above, the out-of-network doctors couldn't send those big bills to the patients, who'd be all set after paying their emergency room copays.

The doctors would instead have to work with patients' insurance, which would pay the greater of the following two amounts:

• The median in-network rate negotiated by health plans
• 125 percent of the average amount paid to similar providers in the same geographic area

The Senate proposal would also require out-of-network doctors and hospitals to tell patients that they are out of network once their condition has stabilized, and give them the opportunity to transfer to an in-network facility.

[...] it's pretty good policy too! That's the general feedback I got from Zack Cooper, an associate professor at Yale University, who, along with his colleague Fiona Scott Morton, has done a lot of pioneering research to uncover how frequently and where these surprise bills happen.

"It is fantastic that they're doing something, and that it's bipartisan," he says. "It's one of those areas where we can agree what is happening now is not good, and this gets us 80 percent of the way to fixing it."

[...] "My concern here is that in-network rates are already quite high, so we're cementing that into the system," he says. "The current world gives emergency physicians tremendous power in negotiating higher in-network rates."

See also: Emergency room visit costs: what's the price of care?

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