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AHA Principles Set Framework for Surprise Billing Solution; Hospital Groups Offer Support to Federal Leaders

February 21, 2019

The American Hospital Association (AHA) has developed a set of principles to serve as a guidepost for work with Congress and the Trump Administration to protect patients from surprise billing.

Surprise bills occur when a patient receives care from an out-of-network provider or when his or her health plan fails to pay for covered services provided at an in-network facility. The AHA principles are intended to address three common surprise billing situations:

  • A patient accesses emergency services outside of their insurance network, including from providers while they are away from home
  • A patient has acted in good faith to obtain care within their network but unintentionally receives care from an out-of-network physician providing services in an in-network hospital
  • A health plan retrospectively denies coverage for emergency services saying they were unnecessary

Congress and the Trump Administration have identified the issue of surprise bills as a priority for this year. The AHA wants to work with leaders to identify workable solutions that protect patients from surprise bills in the scenarios described above.

To that end, the AHA Board of Trustees appointed a member task force to consider balance billing and price transparency issues. More than 200 members of the AHA’s Regional Policy Boards, councils, committees, and other leadership groups provided input. The AHA Board approved the following principles this week:

  • Protect the patient: Any public policy solution should protect patients and remove them from payment negotiations between insurers and providers
  • Ensure patients have access to emergency care: Any public policy solution should ensure that patients have access to and coverage of emergency care
  • Preserve the role of private negotiation: Any public policy solution should ensure providers are able to negotiate appropriate payment rates with health plans
  • Educate patients: Any public policy solution should include an educational component to help patients understand the scope of their health care coverage and how to access their benefits. Insurers, providers and employers would each have a roles in this initiative
  • Ensure adequate provider networks and greater health plan transparency: Any public policy solution should include greater oversight of health plan provider networks and the role health plans play in helping patients access in-network care
  • Support state laws that work: Any public policy solution should take into account the interaction between federal and state laws, and allow for state solutions that are working to remain intact

In a demonstration of commitment to address the problem, the AHA, Federation of American Hospitals, America’s Essential Hospitals, the Association of American Medical Colleges, Catholic Health Association of the United States, and Children’s Hospital Association, sent a letter to Congressional and committee leadership. They outlined key principles and asked to be part of discussions to find a solution.

Surprise bills cause patients unnecessary stress and additional financial burden when they are most vulnerable. HAP supports the AHA’s broad principles and has reconvened a state association task force, established last year, which is committed to analyzing proposals to remove this burden from patients. Legislation also is being contemplated at the state level.

HAP and its members look forward to working with the Pennsylvania Congressional delegation, national hospital groups, and other provider groups to identify a federal legislative solution. As additional details become available, HAP will engage its task force and update HAP members.

For additional information, contact Laura Stevens Kent, HAP’s vice president, federal legislative advocacy, or Jolene Calla, Esquire, HAP’s vice president, health care finance and insurance.

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