AHA Outlines Guiding Principles for Surprise Billing Policy

February 26, 2019

On February 20, a coalition of hospitals led by the American Hospital Association (AHA) released an outline of guiding principles to inform policymakers as they craft legislation to protect patients from “surprise billing.”

In addition to defining surprise billing scenarios where patient protections should be considered, the letter to key congressional leaders highlighted the following principles:

Protect the Patient. Any public policy solution should protect patients and remove them from payment negotiations between insurers and providers. 
Ensure Patients Have Access to Emergency Care. Any public policy solution should ensure that patients have access to and coverage of emergency care. 
Preserve the Role of Private Negotiation. Any public policy solution should ensure providers are able to negotiate appropriate payment rates with health plans. 
Educate Patients. Any public policy solution should include an educational component to help patients understand the scope of their health care coverage and how to access their benefits. 
Ensure Adequate Provider Networks and Greater Health Plan Transparency. Any public policy solution should include greater oversight of health plan provider networks and the role health plans play in helping patients access in-network care. 
Support State Laws That Work. Any public policy solution should consider the interaction between federal and state laws.

WHA staff are currently developing a 2019 strategy for WHA’s Transparency Taskforce to solicit member feedback on state-level policy guidance. 

If you have any questions, contact WHA’s Vice President of Public Policy Lisa Ellinger or Director of State and Federal Relations Jon Hoelter

This story originally appeared in the February 26, 2019 edition of WHA Newsletter