Washington, D.C.—The American Cancer Society Cancer Action Network (ACS CAN) is calling on the Departments of Health and Human Services, Labor and Treasury to put cancer patients and survivors first when implementing rules around surprise medical bills. Surprise medical bills are bills that result from a patient unexpectedly receiving care or a service from an out-of-network provider, often during an urgent situation, where the patient is not aware of the discrepancy. In 2020 Congress passed the No Surprises Act prohibiting these kinds of bills and the Departments are set to implement rules around the law in the coming months.
Among the most pressing issues for patients is how an “emergency medical condition” is defined under the law. ACS CAN and patient groups are supporting the Departments’ rule that an emergency cannot be determined based only on the patient’s final diagnosis. This provision protects patients from surprise bills and from being dissuaded from seeking emergency care. ACS CAN also wants the Departments to closely monitor insurance appeals and complaints around this issue should action need to be taken against a specific insurer or provider.
“We’re very pleased that the Departments have put patients first when it comes to developing strong rules against surprise medical bills, especially in urgent situations,” said Lisa Lacasse, president of ACS CAN. “As such, we want to be sure those rules are closely followed so patients don’t have to choose between financial stability and medical treatment.”
Additionally, ACS CAN is urging the Departments to ensure that once a patient enters an in-network facility to receive care, they will not be surprise billed by any health care providers who happened to be out-of-network for them. The current rule still allows certain provider types in this situation to issue surprise medical bills—also known as balance bills—if they get the patient to sign a notice and consent form. Currently the Departments are proposing a three hour notice for a service that was scheduled that day during which time a provider can ask patients to waive their protections under the law. However, by that point patients may already be prepped for their procedure – including having undergone invasive testing required of many cancer patients – and asking them to waive their rights to financial protection under the law before receiving treatment could feel very coercive. ACS CAN is asking that surprise bills be prohibited at in-network facilities without exception.
Cancer patients are especially apt to encounter these kinds of bills as they often must see a variety of providers at multiple facilities. When ACS CAN surveyed cancer patients and survivors in October 2019 – before the passage of the No Surprises Act – 24% of survey respondents said they had received a surprise medical bill. Sixty-one percent of the surprise bills were for over $500, and 21% were $3,000 or more. Receiving surprise bills negatively impacted respondents’ behavior, making them more likely to experience anxiety about receiving another surprise bill or paying for treatment, less likely to follow up with a recommended specialist who may be out of network, and less likely to call an ambulance or visit the emergency room when experiencing a serious health issue related to their cancer. These impacts are more severe among lower income cancer patients and survivors.
“Clearly it’s important that this law be implemented with the strongest patient protections top of mind. Cancer patients and survivors need to be able to get the right care at the right time and at a cost they can predict,” said Lacasse. “We urge the Departments to put in place the strongest rules possible to make the goals of the No Surprises Act a reality for patients across the country.”