People of all ages love to be surprised, but not with the surprise of unexpected medical bills. We all have been to the doctor for a procedure or even had to go to the emergency room with the expectation of receiving some type of bill for the services provided.

But what happens when you go out to your mailbox and open one bill for thousands of dollars even though you had medical insurance and were under the impression that the insurance would take care of the majority of the bill? We may soon have an answer to this problem with the help of Congress.

In June of 2019 a Senate team favored a decision to focus on surprise billing. This was all brought to light by two Yale economists, Zack Cooper and Fiona Scott Morton, who uncovered the large amount of out-of-network billing for emergency departments. In their discoveries they have not only found the reason this is happening, but also a solution to the problem.

Their research, which was first announced in 11/2016, quickly gained the attention of the media and lawmakers. After evaluating information obtained from a commercial insurance company, they found that one in five patients who visited “in-network” emergency rooms were seen by an out-of-network doctor and could possibly receive an out-of-network or “surprise” bill. One solution that was suggested was to combine facility and physician charges, and also pay physicians directly while staffing their own emergency rooms.

This research that gained so much attention that it was published into an article in The New York Times with the title, “Surprise! Insurance paid the E.R., but Not the Doctor”. After this article was published, the researchers were being contacted by lawmakers and started to make trips to the capitol to work with lawmakers who wanted to pass a bill regarding surprise billing.

As of 7/2019 the “Lower Health Care Costs Act” was passed, which has many elements to it, but one important part of the act was the focus on surprise billing. This act covers the interest of the patient because it proposes to furnish reimbursement to the surprise provider within the average “in-network” rate in the area care is provided. As with much change in this industry, many providers and insurance companies are fixed on not wanting this change.

As much as this may seem like it will cause a huge uprising in the health care industry, this will not be the case. Because this act only applies to surprise bills, this will have no effect on providers who create contracts with patients’ up front in regards to paying a particular price. If a patient is agreeing on a price up front, there is no surprise when the bill comes.