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As Congress examines how to address surprise medical billing, patient advocates and industry stakeholders weigh in

A stethoscope rests on a medical bill
A stethoscope rests on a medical bill
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Congress is pushing to address unexpected medical bills that often leave patients with surprise fees.

Both Democrats and Republicans have found common ground in assessing protections from unexpected charges to patients. But players in the healthcare industry are divided on how the solution would attack the problem and what, exactly, the federal government’s role should be.

To that effect, the House Education and Labor Committee held a hearing on Tuesday examining how to best  protect patients from surprise charges. These kinds of charges could happen when, for example, you visit a hospital that’s in your insurance network for a procedure but one of the specialists isn’t in-network. Patients then get a bill for the difference between their charge and what insurance covered. Both insurance providers and hospitals agree that this so-called “balance billing” is a harmful practice to consumers, but they differ on the best way to do it. There are currently two proposals in front of Congress: one would cap prices that out-of-network providers get, essentially preventing those providers from directly billing patients. The other would force the hospital and insurer to negotiate a fair price, an approach that patient advocates would prefer not to see pass.

Voters also see this as a significant concern, with two-thirds of U.S. residents expressing worry about their ability to afford unanticipated charges. 

Have you ever received a surprise medical bill? How did you handle it?


Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy

Molly Smith, vice president for Coverage and State Issues Forum with the American Hospital Association, a trade group that represents nearly 5,000 hospitals, health care systems, networks, other providers of care

Kristine Grow , senior vice president for public affairs at America’s Health Insurance Plans (AHIP), a national association representing health insurance companies