vox

The key information that hospitals have is the prices they get paid. Policymakers don’t have access to that information. Insurance plans have partial access because they know the prices that their plan pays for medical services — but they don’t know the prices that other insurance plans are paying. This data is really crucial to understanding how much health care costs — it’s also important for patients in terms of understanding how much their doctor visit or ER trip will cost them. Without it, its a lot harder for policymakers to come up with good solutions because we don’t know everything we’d like to about the problem.
—Sarah

I do have thoughts on this! I think the key thing here is that insurers don’t actually have much leverage in negotiations with hospitals. It’s really hard for insurers to exclude a hospital from their network. This is especially true in rural areas where there might be just one hospital, for well-known hospitals (like Cleveland Clinic or Mayo Clinic) or speciality hospitals (like children’s hospitals). It would be really hard for insurers to sell plans without those type of providers, which gives hospitals a lot of leverage. Meanwhile, hospitals tend to have access to a decent number of revenue streams — multiple private insurers as well as Medicare and Medicaid. I think this lopsided dynamic leads to a situation where insurers don’t exert downward pressure on prices. It’s easier to pass along a rate hike to customers rather than explain why the hospital that patients want to go to won’t be included in the network.
—Sarah

Definitely agree that this seems like the type of health policy issue that should move relatively quickly. You have Democrats and Republicans who want to fix this, are coming up with policy proposals that have already been tested in the states, and patients complaining about the issue. That being said, it seems to me that balance billing legislation could end up stuck in the general gridlock of Washington. There are some powerful interests who would likely oppose these bills (hospitals, for example), and that could also slow things down. From what I can tell, there seems to be more momentum right now behind plans to reduce prescription drug pricing (likely an issue that affects more patients), than there is around balance-billing.

I think if this does move forward though, it will be part of some larger package of legislation rather than a stand alone bill. Bills like this often have better odds when they get tacked on as a smaller part of a bigger bill.

—Sarah

This is definitely something we're exploring, but no firm plans right now. Stay tuned!
—Sarah

This is probably the question I get the most ever since I started working on ER bills. It's a really hard space to give advice on though, because people going to the emergency room often have little say over the care being provided to them — especially if they're dealing with a life-threatening, traumatic situation.

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That being said, I think patients are well within their right to ask their doctors why a certain procedure is being done, whether its necessary, and how much it will cost. Sometimes, doctors won't have the information available. But sometimes they will, and it will at least kick start a conversation about whether this is the right treatment path for you. If possible, I'd also recommend asking the emergency room providers — or the person at the front desk — about whether they and other doctors in the ER are in-network with your health insurance. Some of the biggest bills I see are from patients who went to in-network ERs, but were seen there by an out-of-network doctor.

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This isn't always possible but, when it is, it could be a good way to get a better grasp on what your health care costs might be.

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—Sarah