Health Agents for American (HAFA) stormed Capitol Hill last week and several of its top agents were invited to a round table discussion at Centers for Medicare & Medicaid Services (CMS), also known as The Federal Marketplace.
We were able to bring our concerns and experiences dealing with the Marketplace directly to the CMS staff.
The trip to Washington also provided us with the opportunity to hear from our legislators on healthcare issues that are currently being addressed in the Senate. According to HAFA President/CEO, Ronnell Nolan, "We learned about exciting legislation from Senator Bill Cassidy to fight balance billing."
Members of the bipartisan Senate health care price transparency working group, released draft legislation to protect patients from surprise medical bills. The draft bill is intended to jumpstart discussions in Congress about how to best stop the use of balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.
Recent examples of patients receiving surprise medical bills referenced by HAFA include a patient who received a bill of nearly $109,000 for care after a heart attack, and a patient who received a bill for $17,850 for a urine test.
The discussion draft of the Protecting Patients from Surprise Medical Bills Act addresses three scenarios:
1. Emergency services provided by an out-of-network provider in an out-of-network facility:
The draft bill would ensure that a patient is only required to pay the cost-sharing amount required by their health plan, and a provider may not bill the patient for an additional payment. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.
2. Non-Emergency services following an emergency service from an out-of-network facility:
The draft bill would ensure that if a patient receives an emergency service from an out-of-network health care provider or facility and requires additional services after being stabilized, the health care facility or hospital will notify the patient, or their designee, that they may be required to pay higher cost-sharing than if they received an in-network service and give the patient an option to transfer to an in-network facility. The patient, or their designee, would also be required to sign a written acknowledgment of that notification.
3. Non-Emergency services performed by an out-of-network provider at an in-network facility:
The draft bill would ensure that a health plan or out-of-network provider cannot bill a patient beyond their in-network cost-sharing in the case of a non-emergency service that is provided by an out-of-network provider in an in-network facility. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.
No, I’m not running for office. That would be absurd. But I have been chosen to serve on a very elite board with other agents around the country. Approximately fifteen agents were chosen to serve as liaisons with CMS or as you know it… HealthCare.gov. The board discusses topics of concern, ways to improve, how to make the experience easier for the consumer, etc. We have made great strides this past year, and on Wednesday I head down to meet with Randy Pate, CMS Deputy Administrator and the Director of the Center for Consumer Information and Insurance Oversight.
I won’t bore you with all the details but I do want to ask if you have any concerns or comments regarding Healthcare.gov and the MarketPlace. Good experiences? Bad ones? I would love to hear back from you and will be happy to report any and all concerns. Believe me, I have plenty to talk about since I’ve worked through most of them with all of you, but do you have any of your own that you want me to bring to the table?
Feel free to email me, private message me, call me – whatever you’d like. Just let me know today or tomorrow because I head out on Wednesday. I can’t say it enough friends, it’s an honor and privilege to serve all of you! My life wouldn’t be the same without you!
There have been reports that individuals are receiving robocalls across the country that falsely claim to be made by “Blue Cross and Blue Shield.” These calls may seek to market insurance products or collect personal information from call recipients. Blue Cross and Blue Shield of Louisiana is NOT making these calls.
If you receive one of these recorded calls claiming to be from Blue Cross and Blue Shield, there are tips you should follow: