Senate Eyes Creating Out-of-Network Billing Limits

Sen. Lisa Murkowski (R-Alaska) is leading a push to ascertain how Congress could curb excessive out-of-network billing, as her state's attempted correction has only served to further hike healthcare costs, reports Modern Healthcare . Alaska in 2004 released a little-known rule to check exorbitant bills for people with commercial insurance needing out-of-network treatment. The rule stipulated insurers pay 80 percent of the reasonable market rate of the treatment, but was mostly ineffective because unregulated specialists ran up prices. Murkowski said other rural states could face similar problems with too few specialists. As hospitals cannot afford to employ these doctors full-time, their services typically are out of network. This problem narrowed debate at a Senate Health, Education, Labor, and Pensions Committee hearing on Sen. Lamar Alexander's (R-Tenn.) push to find policies to reduce healthcare costs. The Harvard Global Health Institute's Dr. Ashish Jha suggested in Alaska's case, linking benchmark prices to a national average instead of the local specialists' costs could drive incentives the other way. Panel witnesses called on lawmakers to weigh other transparency measures beyond out-of-network billing rules, criticizing the industry because beneficiaries are largely kept unaware in terms of cost of care and the coverage they can expect when they enter hospitals. Jha also noted the Federal Trade Commission and other agencies responsible for monitoring antitrust issues as the industry consolidates need congressional support.