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Protect Consumers from Surprise Medical Bills, Prevent Unsustainable Cost Growth

Surprise medical bills reflect the breakdown of truth, transparency, and fairness in the healthcare system. Patient must be protected from surprise medical bills today and from unaffordable healthcare in the future.

Surprise medical bills pose a well-documented and immediate threat to all patients. Consumer Reports urges Congress to pass legislation to protect consumers from out-of-network balance billing, which occurs when an insured patient, through no fault of their own, is treated by an out-of-network provider, and then is charged the difference between the rate their insurer pays the provider and the provider’s billed charge. This amount is often many times what the consumer’s in-network cost-sharing responsibility would be. Consumers who have health insurance, frequently a large cost itself, should not have their personal finances threatened by out-of-network care that is out of the patient’s control. And yet, for millions of patients a year, that is the current reality. Legislation that takes consumers out from the middle of billing disputes, and which applies to all forms of coverage, is the only solution.

The solution to surprise medical bills must not further inflate out-of-control healthcare costs. Getting the details right is as important as choosing the right reimbursement method. This fact sheet explains why benchmark payment is the best option for fairly compensating providers while keeping healthcare affordable in the future.