Transcripts For CSPAN House Ways Means Hearing On Surprise

CSPAN House Ways Means Hearing On Surprise Medical Bills July 14, 2024

Were getting this going after votes. The house subcommittee will come to order. Brief Opening Statements and then two panels. Welcome all of you for coming. This is the Third Session of congress in which i have introduced legislation to ban the practice of surprise billing. Todays bipartisan hearing represents an initial effort by this committee to finally offer some relief to patients whove been bearing the brunt of a dispute between their insurers and some of their Health Care Providers. For patients, you can take all the right steps in attempting to see that your care network is covered but you may still face big bills. One in seven americans have received a surprise bill as part of receiving care at a hospital that is actually within their Insurance Network. The problem in san antonio, one of the communities that i represent, has been so extensive that jay avola has initiated an entire Television Series called show me your bill. And i think a quick video clip from that adequately demonstrates the problem. Ill ask that it be shown at this point. [video clip] twothirds of americans say they worry about receiving an unexpected medical bill. A surprise bill you thought your insurance would cover. Tonight news 4 troubleshooter jay alvarez launching a way to fight back. Show me your bill. There are two main types of surprise bills. When you go to an emergency room thats not in your Insurance Network and they charge you for the portion your plan wont pay, or one of the doctors isnt in network. So you get a big bill from them. Then you get the runaround trying to straighten it all out. But starting tonight, show me your bill and well go to bat for you. Lavera vincent is a good example. She paid 750 a month for insurance coverage. One day she began suffering chest pain and says she actually called ahead to make sure the emergency room took her insurance. I got this cardiac issue going on but im still going to make sure im doing the right thing financially for me. And so they assured me that yes, i am in network. But, surprise. The metropolitan Methodist Emergency Center wasnt in network. Neither was Northeast Methodist Hospital where she was transferred for further testing. The total charge for two night hospitalization, 31,000. Laveras insurance paid only what it says was reasonable and customary. 9,700. Methodist health care billed her for the rest. 22,000. Ive never had a bill collector call me ever. And its a horrible feeling. Lavera says bmpefore it got to this point, she tried for two years to negotiate with both methodist and her Insurance Company. I felt like i was on a ferris wheel. I would get somebody and theyd say im not the person. Id tell somebody else my story, they would transfer me somewhere else. So she showed me her bill. After several phone calls i got a response from allied national who blamed the situation on the provider Methodist Health care. The provider is billing ms. Vincent their retail rate which no Insurance Company ever pays. Most providers when they take the time to look at the reimbursement rate would be more than satisfied with the payment made by her health plan. So i contacted Methodist Health care which said the Insurance Company was at fault. Ms. Vincents Insurance Plan limited her coverage. Allied insurance paid an arbitrary rate of reimbursement that did not appropriately cover the costs of Services Provided to ms. Vincent. At least i was able to go back and see her with gootd news. Methodist hospital says it has accepted what her insurance paid and canceled the rest of her bill. Instead of 22,000, she now owes nothing. I feel so relieved. I am so grateful. And i know shes relieved, but we cant rely on Media Exposure to solve these problems. Shes also not a typical consumer caught in this situation. She served as executive director of the San Antonio Restaurant Association and yet she had these kind of difficulties. Another example is drew calvert, a Public School teacher with Health Insurance from his school job. He received out of network care after a heart attack and he almost had another heart attack when he got the 100,000plus bill. Only after his story was reported at kut austin for npr did he get relief as the story got out. Others got relief also and drew was invited to the white house to tell his story with the president. With nams consent, im entering his statement about his experience into the record. But as we move forward, we have some protections from the states that are being implemented. In fact, one that was improved in texas last evening. But i think well hear that federal action is essential since in texas, for example, 40 of insured individuals are insured under arisa plans. To address the gap in protection, the in surprise billing act which i referred to is designed to protect insurance patients from being trapped between an insurer and an out of Network Provider. Its the sole focus of the bill. Originally that concept when i first introduced it faced a great deal of opposition. In texas, for example, the only remedy until this until yesterday and a bill that i think is not finally approved in the legislature, the only remedy offered was for the patient to negotiate directly with the Health Care Provider in a little known mediation system that has helped some but omitted many. Fortunately there now appears to be a growing consensus, most recently joined by President Trump, that holding the patient harmless should form the foundation for any surprise billing proposal. Under the legislation that i advance, patients would only be charged in network costs in emergency situations. In nonemergency situations, out of Network Billing would be permitted only after receiving effective notice regarding any providers and Services Together with estimated charges. No other bill addressing this issue has yet been filed here in the house. But there is a very useful discussion draft proposal that is being circulated on a bipartisan basis by the house energy and Commerce Committee. And theres several proposals that have serviced in the senate. While every proposal currently begins with the basic premise of the in surprise billing act, conflict remains on how to ensure provider disputes. Thats what well hear about today from those that have the most direct stake in it. Our house subcommittee hearing has been organized on a bipartisan basis to hear what they have to say to see if we can find ways of resolving that dispute. But my primary concerns remains to ensure that nothing stands in the way of federal action to remove the patient from being in the middle of a dispute. That the patient cant control. The leading proposals have pros and cons that well hear about. And i think that while condemning surprise billing, President Trump has rejected two principal approaches. One for arbitration and one for rate setting. And its unclear exactly which proposal he supports, but i think his support is very important to resolving this. The administration has offered bundling payments as a result as well. I support any solution that can get 218 votes here in the house and protect patients, gain senate approval, and his signature. And i look forward to the discussion that well have today to identify points of agreement so that patients no longer bear the brunt of this dispute. And with that, i would ask mr. Nunes for his opening statement. Thank you, mr. Chairman. I appreciate your willingness to work in a bipartisan manner on this important issue. I want to thank all of you for your attendance here today. Theres going to be a lot of perspectives and im very grateful for the members of congress that are here today. Miss porter and miss mcmorse rogers. Unfortunately, butler cannot be here because shes nine months pregnant. So hopefully everything is going well and hopefully she doesnt receive any surprise billing. But i want to be clear. Critical sectors from our economy could not come to find a way to Work Together to protect patients from these huge surprise bills. Instead we are here exploring a government solution to the problem. Weve all heard the ridiculous stories. 600 bandaids, 60 ibuprofen, 5,751 ice pack. The patient with the 5,000 ice pack reportedly went to the emergency room after hitting her head and cutting her ear but ended up leaving without care because the Plastic Surgeon who would see her was an out of network for her Insurance Plan. She wanted to avoid a big bill so she left the ice pack and a bandage. Her Insurance Plan paid 862 which it deemed appropriate and responsible fee for services. The hospital then sent the patient a bill for 4,889. My state of california already has a pretty robust protections against balance billing patients. Going so far as to set a requirement reimbursement scheme. Which im sure some of you like and some of you do not like. But im not interested in watching a food fight between everyone. I want to hear common sense targeted solutions that can help solve different aspects of the surprise billing problem. I want to talk about the policies that increase price transparencies. And help make informed decisions about their health care. In nonemergency schedule situation, doctors and hospitals should be able to work with the Insurance Companies they contract with to get patients an estimate of their total cost of care and their total cost sharing obligation before they get services. Or treatment. And patients should be notified about whether or not the Health Care Providers who will be involved in their care in their Insurance Network. That could go a long way with preventing these eyepopping bills. Another type of surprise happens when people were unknowingly seen by an out of network doctor. Perhaps hospitals responsible for those practices in the walls should be held responsible for issues between democracyoctors and Insurance Companies in such circumstances. One of them wont surprise the patient later with an out of Network Balance bill. To me the organizations represented on our second panel have the power and i would argue the responsibility to solve the issue for patients. I think there are a lot of different steps you should voluntarily take to protect your patients and policy holders. Many states are working on solutions either improving existing laws or creating new ones. I know both sides of the aisle in congress are interested to find a solution that protects patients. I look forward to all of the constructive testimony today. And i hope we can deliver some solutions. With that, i yield back. Thank you. Thank you for your helpful statement. We have two panels today. The first composed of two of our colleagues. Congresswoman katie porter, congresswoman Cathy Mcmorris rodgers. Mrs. Porter, if you begin. Thank you for holding this hearing today. I am concerned about surprise billing as someone whos dedicated my life to protecting consumers. But also because i have had to fight my own battle with surprise billing. On august 3rd last year when i was on the campaign trail, i started to feel pain in my abdomen. At 1 00 p. M. , i could not continue and i went home. At 4 31, i texted my Campaign Manager that i needed to go to the emergency room. I couldnt safely drive through the pain and i remember sitting on my front porch so if i lost consciousness, somebody might find me and i wouldnt be home alone. I didnt call an ambulance because i was concerned about the cost. I could not drive and i asked my manager to please take me to hoge hospital. I chose to hospital even though it was farther away from other providers because i knew hoge was an inNetwork Facility. When i got to the hospital, i waited six hours alone in the emergency exam room without treatment. When i finally went to surgery, my doctor told me it was nothing to worry about. Just a routine appendectomy. I was given anesthesia. When i awoke, the team around me was panicking. They couldnt get my temperature to drop and couldnt get the Blood Pressure to rise. My appendix ruptured hours before with an infection making my whole body sick. I spent the next five days in the hospital receiving powerful iv antibiotics. A few weeks later i received the bill from this Insurance Company. The idea of an astronomical medical bill weighed heavily on me. I was happy to see the cost of my emergency room treatment and assessment hospital charges and nearly all of my Inpatient Services were covered. I remember sitting at my Kitchen Table and taking a deep breath filled with relief. But a few days later, i received another bill. This one from my surgeon. While the hospital i had gone to was in network, the Insurance Company now claimed the surgeon was not. Even though they had sent me a notification telling me that my surgeon was in network. Enclosed in that bill for nearly 3,000 was a handout from my surgeon detailing the steps i would have to take while recovering in order to fight to have my Insurance Company cover the care. So many of his patients had been put in this situation, that this medical doctor had used his staff to address patient billing problems. Thats not what he trained for in medical school. These socalled explanations of benefits and the surgeons handout explained he was being treated as an out of Network Provider even though he was employed by and worked at an innetwork hospital. As someone in an emergency situation, i had no ability to assess whether he was in or out of network and in those cases. But i got that bill because my insurer put profits before patients. I called my Insurance Company to request an appeal. The benefits manager kept asking me questions to guide me and coach me toward saying that it was my surgeons fault, to blame him for overcharging me. She asked me to call the surgeon and attack my doctor for his bill. Apparently to anthem blue cross, 3,000 was too high a price for saving my life. The tens of thousands in premiums i paid to that company over the years were not enough to have them cause them to cover the lifesaving care. Nearly five months after i was hospitalized, the surgeon simply requested payment. And at that point, i reached out to my employer, the university of california irvine. Thats when i learned that uc irvine has a designated patient advocate. A medical doctor whose sole job is to help University Employees get the Health Insurance that the university and the employees pay for. Can we just reflect on that for a moment . The university is paying a medical doctor to do nothing but navigate insurance. Finally, the patient advocate invoking the fact that i had been just elected to congress, was able to get the Insurance Company to agree to pay my surgeons bill. But heres what i learned from getting sick. I am well educated. I had an employer prepared to help me. I have professional experience fighting for consumer rights. But there are thousands of americans with fewer resources than me who are surprised with bills far more devastating than mine. Im here today because i refuse to accept this as the status quo. I refuse to stand by while families go bankrupt because of Surprise Medical Bills. Any solution to this issue must rely must not rely on the patients ability to go to war with the insurer or with their provider. That is not the solution. Its time we start putting patients first. Thank you for inviting me here today. Thank you for sharing your experience, miss mcmorris rodgers. Thank you. Try this again. Ch thank you for holding this important hearing on protecting patients from surprise medical billings. Im grateful for your leadership to examine this problem so congress can work on a bipartisan solution. You know, theres so many stories out there. I was going to share another story of a lady from Washington State who had a massive heart attack and ended up in a surgery place, hospital in oregon which led to all kinds of challenges. And to save her life, she had bypass surgery, a valve replacement and repair. She ended up spending a whole month in the hospital recovering from the surgery ranging from an infection and needing more powerful antibiotics. She was discharged and she received her bill. She owed nearly 227,000. So this one was more than a surprise bill. It was massive. It was suppresstressful. And it was devastating. She eventually was able to get help and relief with a complicated medical charity care waiver. But it took six months of uncertainty and countless phone calls from collection agencies. It shouldnt have to be this way. Especially when someone is recovering from a heart attack. What makes this story even more painful is that nobody told her that she could have been transferred to an innetwork hospital. Which could have saved tens of thousands of dollars. As she said, there should be fairness and equality in the system. You shouldnt have to file a complaint. This should be engrained into the system so when you have a problem and youre due relief, you get it. And s

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