How to Stop Surprise Medical Bills

There have been a number of reports published recently detailing the surprisingly large medical bills that individuals have received after receiving treatment at a hospital.

There was the story of the emergency room doctor who was billed $30,000 for life-saving treatment after suffering an injury while surfing. There was the story of the heart attack patient who received a bill for $109,000, which got a lot of people up in arms. Thankfully, that story appears to be heading toward a happy ending for everyone.

The problem is a process known as balance billing, which happens when an individual is charged for the difference between what the facility and the insurance company thought the care was worth.

There might be a solution to this problem, and it comes by updating a 45-year-old law — the Employee Retirement Income Security Act (ERISA) — which governs self-funded healthcare plans.

About 60% of employees with health insurance have self-funded plans, according to a published report. Kaiser Health News has a number of recommendations to help stop the balance billing problem.

  • Federal legislation to prohibit balance billing for emergency services, which is unlikely to gain the necessary bipartisan support it would need to become law
  • Revised regulations from the Department of Labor, also considered to be a longshot
  • Getting more states to enact laws protecting consumers from surprising medical bills. About two dozen states currently have such laws on the books.

Nobody is holding out hope that this will be addressed anytime soon.

“As long as providers can charge whatever they please, the problem won’t go away,” said Loren Adler, associate director at the University of Southern California-Brookings Schaeffer Initiative for Health Policy.


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