Cassidy suprise bills

U.S. Sen. Bill Cassidy, R-Baton Rouge, explains a bipartisan proposal to protect patients from receiving exorbitant surprise medical bills, as co-sponsor Sens. Maggie Hassan (D-NH) and Todd Young (R-IN) look on during a news conference at the U.S. Capitol in Washington on May 16, 2019.

WASHINGTON — U.S. Sen. Bill Cassidy is leading a bipartisan effort to introduce legislation meant to prevent people from receiving “surprise medical bills” when they inadvertently receive treatment out of their insurance networks — a frustrating health care issue that affects countless patients each year.

“Patients should be the reason for the care, not an excuse for the bill,” the Baton Rouge Republican said at a news conference explaining a proposal months in the making. “The patient should be held harmless.”

Surprise medical bills happen most often after someone seeks medical care in an emergency room. A common scenario is when the hospital is in network, but the patient is treated by an out-of-network doctor. Additionally, some specialists, who are brought in for surgeries and other procedures, such as anesthesiologists, can be out-of-network and prompt additional out-of-pocket costs.

The issue is one Cassidy, a medical doctor, has repeatedly raised, trying various proposals to eliminate the sticker shock he has heard about from constituents.

The legislation, formally called the STOP Surprise Bills Act, could get its first committee vetting by the end of the month if all goes according to plan, Cassidy said.

After quietly tolling away on hashing out a final proposal, the idea gained a public resurgence last week when Cassidy and other sponsors of the bill joined President Donald Trump for a news conference on the topic at the White House.

“If we get this the way we want it over the next two weeks, I think you’re going to see something really great," Trump said at the time. “It’s something that will have a tremendous impact.”

They were joined by patients who told stories of facing thousands of dollars in unexpected medical bills when they received treatment from out-of-network providers without their knowledge.

Senators who took part in Thursday’s meeting said they often hear similar stories from their constituents.

“Consumers want to know what they are paying at the time they receive care, not months down the road when they receive a bill,” said Sen. Michael Bennet, D-Colo.

“People are mad. They’re upset. They’re frustrated,” Sen. Lisa Murkowski, R-Alaska, said.

Under the proposal outlined Thursday, patients would only be billed for in-network costs for emergency services, even in cases when they are treated at an out-of-network facility or by an out-of-network provider. Additionally, those who receive treatment at an out-of-network facility could only be billed further for in-network costs when they can’t be safely transported to an in-network provider without medical transport.

In non-emergency cases, patients would only pay their in-network share when an out-of-network provider treats them at an in-network facility. That would also apply to out-of-network specialist or lab costs.

Doctors and the insurance industry have long disagreed on how that would work to ensure providers are paid a fair price and insurance companies don’t end up saddled with unnecessary costs.

Cassidy and Sen. Maggie Hassan, D-N.H., merged ideas they have previously proposed to create a plan that would first set a median amount for insurers to pay providers for the out-of-network services, but it also would create a new independent arbitration process for providers and plans to work out disagreements over payment amounts.

The patient would not be a party to the arbitration and would never owe more than the in-network rate.

Hassan said there was a good chance the bill could pass both chambers.

“There is a strong bipartisan momentum,” Hassan said.

Follow Elizabeth Crisp on Twitter, @elizabethcrisp.