AHA Releases ‘Surprise Billing Principles’ as Hopeful Federal Guideline

Surprise Billings

Effort supports legislation to help patients avoid being blindsided by invoices

The American Heart Association recently released a set of guidelines to hopefully aid federal lawmakers in the quest to create legislation protecting consumers from ‘surprise’ invoices from doctors or hospitals.

These types of bills may occur when a patient receives care from an out-of-network provider or when their health plan fails to pay for covered services. However, the AHA clarified that these principle do not hold when a patient chooses to go out of network.

PROTECT THE PATIENT. Any public policy solution should protect patients and remove them from payment negotiations between insurers and providers.

ENSURE PATIENTS HAVE ACCESS TO EMERGENCY CARE. Any public policy solution should ensure that patients have access to and coverage of emergency care.

PRESERVE THE ROLE OF PRIVATE NEGOTIATION. Any public policy solution should ensure providers are able to negotiate appropriate payment rates with health plans.

EDUCATE PATIENTS. Any public policy solution should include an educational component to help patients understand the scope of their health care coverage and how to access their benefits.

ENSURE ADEQUATE PROVIDER NETWORKS AND GREATER HEALTH PLAN TRANSPARENCY. Any public policy solution should include greater oversight of health plan provider networks and the role health plans play in helping patients access in-network care.

SUPPORT STATE LAWS THAT WORK. Any public policy solution should take into account the interaction between federal and state laws.

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