Consumers are increasingly receiving surprise medical bills, where an insured patient is unexpectedly billed directly for medical services received at an in-network health care facility from an out-of-network provider. These situations often arise in emergency rooms, operating rooms, and delivery rooms, despite the efforts of patients to receive care only from in-network providers. Surprise medical bills commonly leave consumers on the hook for thousands of dollars for out-of-network services that they had no opportunity to refuse. This article explores how the steady rise of narrow provider network health plans and the often-corresponding lack of transparency regarding which providers are included in the network has led to an increase in surprise medical bills. It then examines various legislative approaches at both the federal and state level to protect consumers from these unexpected bills. This article ultimately proposes a statutory framework based on a modified version of New York’s law that would effectively remove consumers from surprise medical bill disputes, leaving reimbursement arguments to health plans and providers.
Dunham, Merlow M.
"Avoiding Sticker Shock: Legislative Approaches to Protect Consumers from Surprise Medical Bills,"
Saint Louis University Journal of Health Law & Policy: Vol. 11
, Article 10.
Available at: https://scholarship.law.slu.edu/jhlp/vol11/iss1/10