Congress is taking up the issue of surprise medical bills. Patients routinely receive them despite having insurance they thought would cover fees.
Sonji Wilkes and her family have endured a medical and financial nightmare. Her son, Thomas was diagnosed with a blood disorder shortly after birth. She went to an in-network hospital, thinking her insurance would cover treatment in the neonatal intensive care unit.
“A few weeks later we received another shock. A $50,000 bill for Thomas’ stay in the NICU. We were dumbfounded,” Wilkes said.
The NIC-U was subcontracted to a third-party provider, out of network for the family’s plan. Wilkes testified before a House subcommittee as lawmakers propose legislation to address surprise medical bills which are common.
Another patient advocate testified Wednesday that one in five visits to an emergency room results in a surprise bill. A survey from the University of Chicago shows 57 percent of Americans are surprised by bills they thought would be covered by insurance.
The surprise charges are most commonly for ambulances and specialty doctors, including anesthesiologists and radiologists.
“It is not fair, it should not happen, and we’re going to put a stop to it one way or another,” Representative Greg Walden of Oregon said.
But lawmakers are split on how to fix the problem. One proposal doctors favor includes setting up an arbitration system to resolve billing disputes.
“This cuts both ways. Plans and providers alike will have the opportunity to appeal,” Physicians for Fair Coverage Dr. Sherif Zaafran said.
But insurers reject that proposal.
“It adds unnecessary administrative costs to the system,” Jeanette Thornton with America’s Health Insurance Plans said.
Insurers prefer a single standard payment. A Senate hearing is scheduled for next week.
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