Preventing Surprise Medical Bills During the First 1,000 Days

Few issues can bring the White House, Congress and health care advocates together. But one issue is increasingly receiving strong, bipartisan support: tackling surprise medical bills. This is good news for moms, babies and their families.

What are surprise medical bills?

A surprise medical bill comes when a patient receives services from an out-of-network provider, often through no fault of their own.

Most health plans have a network of health care providers, and it’s cheaper for a patient to use in-network providers. If a patient choses an out-of-network provider, they are responsible for much higher out-of-pocket costs. Some patients will choose to use an out-of-network provider—for example, due to location or because the provider is preferred. When the patient makes the choice to use the out-of-network provider, they do so understanding that they will pay more.

But sometimes, a patient receives a service from an out-of-network provider without realizing it or without consenting. During a health care visit—particularly in a hospital-based setting—multiple health care providers may treat patients, and some of these providers might not be in-network. In this case, patients get treatment from an out-of-network provider through no fault of their own but are still responsible for the higher costs.

How can surprise medical bills affect families during the first 1,000 days?

Many families receive surprise medical bills after childbirth. For example, a woman may choose to deliver her baby at an in-network hospital with an in-network OB-GYN. During her delivery, an anesthesiologist, who is a critical part of the care team, may serve her. But, if the anesthesiologist is out-of-network, the woman will be responsible for the costs of those services.

Sadly, this is a common occurrence. A recent study found that 11% of mothers experienced a surprise out-of-network bill with their first delivery. Not only do those mothers face high and unexpected costs, but they are also more likely to switch from their preferred hospital after receiving a surprise bill.

Whether a patient unknowingly receives the services of an out-of-network anesthesiologist during childbirth or ends up in an out-of-network emergency room during a medical crisis, families shouldn’t have to bear the outrageous costs of out-of-network bills.

What is being done to solve the problem?

Part of a comprehensive solution is up-front transparency about what a patient will pay for the total cost of care. But that’s not enough. Patients should be held harmless from surprise bills and should never have to pay more than their normal in-network cost-sharing requirement for a service.

Many states have worked to address surprise medical bills, and some states have meaningful protections. But most states do not have comprehensive protections against surprise billing, and there is no national policy to protect consumers. This needs to change.

The President and Congressional Leaders have expressed an interest in passing legislation to address surprise medical bills. 1,000 Days urges policymakers to move quickly to ensure that during recovery from childbirth or other medical situations, no one receives a surprise medical bill.