People purchasing health insurance through the Affordable Care Act (ACA) have run into another insurance roadblock, this time because out-of-network doctors providing services for in-network hospitals may bill separately from the hospital, creating expensive, surprise expenses for the patient.
In a recent Time article, it was reported that “An estimated one in three American adults with private health insurance falls victim every two years to what are known, aptly, as ‘surprise medical bills,’ according to a 2015 survey by Consumer Reports. Such bills arise when an in-network medical facility contracts with out-of-network medical staff, including emergency-room doctors, anesthesiologists, surgical assistants or lab technicians.”
The American Hospital Association (AHA), an organization that leads, represents and serves hospitals, health systems and other related organizations that are accountable to the community and committed to health improvement, offers good advice for how such issues can be alleviated for consumers who have insurance through the ACA marketplace.
“Everyone needs to play a role in helping consumers navigate the complicated heath care delivery system,” Marie Watteau, vice president of media relations and digital media at AHA, recently told Patient Daily.
Watteau explained that outside of consumer initiative, it is important that insurers help clearly inform patients of their policy limitations.
“Insurers have the primary responsibility for making sure their network or availability of providers is adequate and that they include hospital-based physicians in their directories and on their websites,” she said. “And they communicate those parameters to consumers.”
Watteau further explained that hospitals are also responsible for informing the patient, so such billing surprises do not occur without knowledge or consent.
“Hospitals also play a role by informing patients that they may be treated by non-network physicians that are not employed by the hospital when the patients are in the facility,” she said. “The AHA was part of the Patient Financial Interactions Best Practices Project, because it is important to have guidance that helps hospitals assist patients with sensitive financial interactions.”
There are also ways each state can protect those who may have no choice but to accept out-of-network treatments while they are in the hospital.
“Many states, such as New York and Texas, have implemented policies that are far preferable for consumers than those proposed in the U.S. Congress and include such things as requiring transparency and disclosures from insurers and providers, restricting balance billing of consumers and initiating an arbitration process to determine physician payment,” Watteau said. “Such state-based solutions provide the relief consumers need and offer an outlet to settle amicably out-of-network bills.”
