WASHINGTON D.C., Dec. 01, 2020 (GLOBE NEWSWIRE) -- With American patients still facing significant exposure to a surprise medical bill amid the current public health emergency, more than 60 groups representing consumers, employers and unions implored Congress to take action against these bankrupting charges. The jointly signed letter sent to the Capitol early this week represents the strongest call yet for federal policymakers to finally put an end to surprise medical billing after private equity firms blocked previous reforms in 2019.

The latest letter highlights the continued push by private equity firms and out-of-network providers to take advantage of loopholes in the market at the expense of patients, even amid the COVID-19 pandemic. If Congress fails to act, private equity-backed specialists will continue to bilk the system, forcing patients and their families to pay $40 billion more each year for their medical care.

“A strong bipartisan solution that prioritizes market-based payments for out-of-network care can address both the ‘surprise’ and the outrageous costs from these predatory bills,” said Elizabeth Mitchell, president and CEO of Pacific Business Group on Health. “Congress must act now by including market-based surprise billing reforms as part of the end-of-the-year legislative package so that all patients are protected by these charges.”

Highlights of the letter are included below:

  • Although this Congress has debated surprise billing legislation for two years, it has failed to end the practice despite the great urgency amid the COVID crisis.
  • A recent Government Accountability Office report highlights the market failure that has led to the egregious practice of surprise medical billing and the need for Congress to stop this practice without increasing premiums. Data also demonstrate that market failure has created a ripe environment for private equity firms to enter health care markets and exacerbate surprise billing at the expense of patients across America.
  • While many surprise billing situations occur in emergency situations when patients are unable to confirm the network status of their providers, they also occur even when a patient has taken every possible caution to avoid out-of-network care. Recent research published in the Annals of Internal Medicine shows 12% of patients undergoing a colonoscopy from an in-network endoscopist at an in-network facility still received a surprise bill from an out-of-network anesthesiologist or pathologist. This is outrageous.
  • Fortunately, new research from the American Journal of Managed Care shows addressing surprise billing could save Americans as much as $212 per year in lower health care premiums. This demonstrates the win-win of enacting comprehensive surprise billing legislation that includes a median in-network benchmark payment – patients will not fear the likelihood of a surprise bill and could save hundreds of dollars in lower health care premiums.
  • As the COVID-19 pandemic continues, and more Americans are faced with urgent or immediate health concerns, the threat of surprise bills from out-of-network specialists, ambulances and private equity backed-providers will increase.

For more information on this effort and other health care policy priorities for America’s largest employers, visit www.pbgh.org.


About Pacific Business Group Health

PBGH is a coalition of large private employers and public institutions dedicated to transforming health care throughout the country with innovative strategies to improve health care quality and control costs. Representing 41 public and private organizations across the U.S that collectively spend $100 billion annually purchasing health care services for more than 15 million Americans, PBGH has a long history of developing, incubating and launching successful operational programs on behalf of and in partnership with large employers. PBGH exclusively represents the interests of large employers and public institutions buying health care services on behalf of working Americans and their families. 


Lisa Zamosky
Pacific Business Group on Health