Surprise medical bills attract attention of Obama administration

Embedded within President Barack Obama‘s 2017 budget for HHS is a provision to “eliminate surprise out-of-network healthcare charges for privately insured patients.” Details are scant, but the administration would try to solve the problem by requiring physicians who “regularly provide services in hospitals” to accept in-network rates, even if they aren’t in the insurer’s network. Hospitals would also have to “take reasonable steps” to ensure patients see in-network physicians.
Patients face unexpected charges usually because of large payment disagreements between insurance companies and physicians. Physicians refuse to participate in an insurer’s network, arguing insurers are low-balling them, but insurers say doctors ask for unreasonably high rates. Hospitals, and patients, are often left in the middle. Under Obama’s budget, patients would be removed from the disputes, and physicians would have to cave to the insurers’ rates. That differs from New York, which recently passed a law that set up an arbitration process for insurers and providers to work out their differences while holding the patients harmless. Other states such as Pennsylvania also are looking into ways to solve the issue.