OPM and a House committee have focused attention to the issue of “surprise” medical bills, which have emerged as a growing concern regarding health insurance.
In its recent letter to insurance providers outlining terms for the 2021 FEHB plan year, the OPM said that “a lack of transparency regarding a provider’s contracting status with an FEHB carrier (in-network, out-of-network, etc.) can often lead to unexpected costs for enrollees.”
“Surprise billing commonly occurs in emergent and urgent clinical settings when members don’t have the opportunity to search for and select their provider. It can also occur when members are unaware of ancillary providers involved in their care (e.g., radiologists, anesthesiologists, pathologists, assistant surgeons), or are unaware that these providers are not in their plan’s network when seeking care at an in-network treating facility. This information is generally not shown in association with the treating hospital or facility in online provider directories, which is usually the primary place where members seek this type of care information,” it said.
A report last year from the Kaiser Family Foundation – not affiliated with the Kaiser medical provider – said that in a survey, surprise medical billing was the number one concern about health-care costs, with two thirds saying they are very or somewhat concerned about it.
Thirty-nine percent of respondents had received an unexpected medical bill in the past 12 months; in 13 percent of those cases the bill was for $2,000 or more.
“We are continuing to look for ways to address surprise billing for FEHB enrollees in the future,” OPM said, such as a requirement that carriers “make it easy for a member to identify in-network and out-of-network services at any given hospital or treating facility contracting with the member’s plan.”
Meantime, the House Education and Labor Committee has approved a bill (HR-5800) that would apply to the FEHB as well as to other group health insurance plans.
The bill would limit cost-sharing to the in-network rate; prohibit out-of-network providers from sending balance bills that exceed the in-network rate; and require that any costs for out-of-network care that would have otherwise resulted in a surprise bill be counted toward the in-network deductible or out-of-pocket maximum.
It further would provide for independent outside reviews of disputed charges and require health insurers to provide fuller information regarding potential costs including in-network and out-of-network deductibles and out-of-pocket limitations.
The measure has bipartisan support and could be brought to House floor voting soon.