After receiving emergency care at an in-network hospital, many patients are surprised to learn they received care from an out-of- network physician like a radiologist or emergency doctor, and now owe big money – hence, the surprise insurance coverage gap.
Patients rely on insurance companies to cover them when they need it most, but insurance companies aren’t honoring their side of the deal. Patients pay their premiums month after month but, long after receiving emergency care, patients receive unexpected “balance bills” that insurance companies refuse to cover. These bills occur because insurance companies are forcing physicians out of network, leaving patients with a surprise bill they thought be covered by their insurance.
Patients can’t choose where and when they will need emergency care and they shouldn’t be punished financially for having emergencies. Health plans are purposefully creating even narrower networks for emergency care, knowing that hospital emergency departments are required by federal law to care for all patients, regardless of their ability to pay. This means insurers can easily shift more medical costs to patients and make record profits. No insurance plan is affordable if it abandons you in an emergency – and that’s exactly what the insurance companies are doing.
Health insurance companies need to stop playing games with patient coverage and concealing their narrowing coverage networks. To solve the surprise insurance coverage gap, we advocate for state legislation that ensures every state’s “Patient Bill of Rights,” including:
We support use of the FAIR Health database, a national data repository that’s bringing clarity to health care costs and health insurance information. As an independent, conflict-free research platform, we believe that the FAIR Health database should be used as the gold standard to determine reimbursement rates, and is vital to closing the coverage gap.
FAIR Health provides a wealth of valuable resources for consumers in their fight against the surprise insurance gap, and patients everywhere can use the FAIR Health Medical Cost Lookup to estimate state-by-state health care costs for specific medical procedures.
Recently, Physicians for Fair Coverage commissioned a study from NORC at the University of Chicago. According to its report, NORC found that FAIR Health is “the only vendor whose data are being used for the specific purpose of establishing reimbursement standards for out-of-network services in more than one state and who currently make their data available for this purpose broadly across the United States.” Read the full research report here (PDF).
There are several ways you can help close the surprise insurance gap. If your state is currently debating this issue, you can write to your state legislators, demanding a change. If this issue isn’t currently on the table in your state, you can still sign up so you’ll know exactly when to take action. What’s more, if you’ve ever received a surprise bill for emergency care, you can share your story with us. Sharing your story helps us show legislators that this is a serious issue affecting real people.
All state legislators seeking to solve the surprise insurance gap should pass a bill that meets the standards we laid out above. To accomplish that, we recommend legislators replace surprise balance billing with laws that:
Are you a state legislator or member of an organization who wants to end the surprise insurance gap? Contact us and we can help get you started with a model legislation.
End the Surprise Insurance Gap is led by Physicians for Fair Coverage (PFC).PFC is a multi-specialty alliance of doctors nationwide, who are advocating to improve patient protections, promote transparency in the health system and increase access to care. Learn more at thePFC.org.