fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

Protect Patients from Surprise Billing

February 04, 2020 | FAH Policy Blog Team

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No patient should ever receive a surprise bill – this is at the core of a set of principles developed by the hospital industry as leaders work to solve this issue.

FAH, the American Hospital Association (AHA), America’s Essential Hospitals, Association of American Medical Colleges (AAMC), Catholic Health Association of the United States and Children’s Hospital Association are committed to protecting patients from surprise medical bills that result from unexpected gaps in coverage or medical emergencies.

The groups have been working with Congressional leaders and other stakeholders for more than a year to find a compromise that treats everyone in the process fairly.

FAH and other hospital associations sent a letter to Congress laying out these principles to act as a framework for a legislative solution to surprise billing:

  • Preserve the role of private negotiation. Health plans and providers should retain the ability to negotiate appropriate payment rates. The government should not establish a fixed payment amount or reimbursement methodology for out-of-network services, which could create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks.
  • Remove the patient from health plan/provider negotiations. Patients should not be placed in the middle of negotiations between insurers and providers. Health plans must work directly with providers on reimbursement, and the patient should not be responsible for transmitting any payment between the plan and the provider.
  • Ensure patients have access to comprehensive provider networks and accurate network information. Patients should have access to a comprehensive network of providers, including in-network physicians and specialists at in-network facilities. Health plans should provide easily understandable information about their provider network, including accurate listings for hospital-based physicians, so that patients can make informed health care decisions. Federal and state regulators should ensure both the adequacy of health plan provider networks and the accuracy of provider directories.

To read the full letter sent to Congress click here.