The 116th Congress finished their reign by passing every section of government funding into law with COVID relief attached. In this episode, learn about the new COVID relief law after you hear about a surprise dingleberry that promises to end surprise medical billing in the United States. That's right! Something good happened! Find out in this episode how the new provisions will positively affect you. Executive Producer: Anonymous Please Support Congressional Dish – Quick Links to contribute monthly or a lump sum via to support Congressional Dish via Patreon (donations per episode) Send payments to: Send payments to: @Jennifer-Briney Send payments to: $CongressionalDish or Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Recommended Episodes Oversights of CAREs CARES Act - The Trillions for COVID-19 Law Surprise Medical Bills Coronabus Outline H.R.133: Congress.gov The Federal government will pay 100% of the cost of funeral expenses that the Governor of a state chooses to pay for expenses through 12/31/2020. : Provides $10 billion and expand eligibility by waiving eligibility restrictions tied to income. It specifically mentions health care sector employees, emergency responders, sanitation workers, farm workers, and other "workers deemed essential during the response to coronavirus by public officials". The money can be used to pay for co-payments and tuition payments for families. : Provides $22,945,000,000 for vaccines and $22,400,000,000 for testing and contract tracing. : Provides almost $82 billion available through September 2022 to “prevent, prepare for, and respond to coronavirus domestically or internationally”. $2.75 billion will go to "non-public schools". Non-public schools can not also take PPP money if they apply for this money. : Provides $2 billion for airports, and requires them to retain at least 90 percent of their workforce as of March 27, 2020 (minus retirements and employees who quit) until February 15th TITLE I - HEALTHCARE Medicare fee schedules will be increased by 3.75% from January 1, 2021 through January 1, 2022. Prohibits judicial review of the fee schedules that determine payment amounts. Funds it with $3 billion plus "necessary" amounts from the Supplementary Medical Insurance Trust Fund. TITLE II - ASSISTANCE TO INDIVIDUALS, FAMILIES, AND BUSINESSES Extends the eligibility period for COVID-19 unemployment payments through March 14, 2021. People who haven't used their benefit eligibility of 50 weeks can get payments through April 5, 2021. Gives individuals the right to appeal denials of their unemployment benefits, but any denials issued before the end of 2020 will stand. Adds $300 in federal tax money to the weekly unemployment benefits we receive from our states from December 26, 2020 through March 14, 2021. Requires people filing for COVID unemployment benefits who aren't usually eligible (such as self-employed people, people who can't work because they are sick with COVID or caring for a COVID, etc.) to provide documentation to prove they are employed or self employed. The law is not specific about what kind of documentation is required. Starting in February 2021, people in this category have to submit documents every week proving they are still, caring for someone who is sick, or can't work for another eligible reason. Requires the states to verify the identity of any approved to receive COVID unemployment payments. States need to start doing this by February 1. By February 1, states have to set up a snitching hotline or website for employers to use to rat on employees who refuse to return to work "without good cause." The definition of good cause is left up to the states. Individuals making up to $75,000 - based on 2019 taxes - will receive a $600 "tax credit", in addition to $600 per dependent A business that receives a PPP loan that is forgiven does not have to count that money as income and expenses paid with the PPP money can be deducted. Students who receive emergency financial aid grants don’t have to count the money as income Extended a tax credit for employers which would cover 100% of the costs of paid sick and family leave they offer to their employees and the tax credit for self-employed people for the days they can’t work because of COVID until March 31, 2021. TITLE III - CONTINUING THE PAYCHECK PROTECTION PROGRAM AND OTHER SMALL BUSINESS SUPPORT Expands the list of expenses that can be paid using PPP funds to include operations expenditures, property damage caused by the BLM protests in summer 2020 that were not covered by insurance, supplier costs, and worker protection measures related to COVID safety. Exempts the banks that administer the PPP program from lawsuits related to loan origination or forgiveness for a second draw of PPP loans as long as they collect required paperwork "in good faith". Creates a simplified application process for PPP loan forgiveness for loans less than $150,000. Those loans "shall be forgiven" if the person submits a 1 page document describing how many employees were retained thanks to the loan, how much of the loan was spent on payroll, and the total loan amount. The recipient will have to retain employment records for 4 years after submitting the application. The banks are not allowed to require any other documents for loan forgiveness. This is effective from the signing of the CARES Act. Clarifies that "group life, disability, vision, or dental insurance" counts as payroll costs, which can be paid using PPP loan money. Allows people to get a second round of forgivable PPP loans with the amount based on their payroll expenses for the last year or 2019 with a maximum loan amount of $2 million. Limits the size of the business to one with fewer than 300 employees per location, instead of 500 employees per location. Allows PPP funds to be given to tax exempt business organizations, including organizations that engage in lobbying Congress. Prohibits PPP funds from being used on lobbying expenses. A business that is more than 20% owned or controlled by the President, Vice President, the head of an Executive department or a member of Congress or their spouses is not eligible to receive PPP loans. Live performance venues, except ones that "present live performances of a prurient sexual nature", that have taken in 30% or less of their 2019 revenues can get grants to help make up for 45% of their lost revenue during the pandemic. $2 billion is set aside for businesses with fewer than 50 employees. Prohibits publicly traded companies from receiving PPP loans. TITLE IV - TRANSPORTATION Provides $15 billion to pay the salaries and benefits of passenger airlines and $1 billion for contractors. Conditions the money on the promise from the airlines and contractors that they won't lay anyone off or reduce their pay until March 31, 2021 and that the money won't be used to buy the companies stock or pay out dividends until March 31, 2022. Airlines or contractors that accept this money will have 72 hours from the time they accept the agreement with government to recall any employees they laid off. The employees who return will receive back pay from December 1, 2020 (minus any severance they received). Freezes the pay of anyone in the airlines accepting our tax money funded bailout who made more than $425,000/year in 2019 to their 2019 pay levels until October 1, 2022. No one in the company will be allowed to collect more than $3 million plus 50% of the amount over $3 million that they earned in 2019. Authorizes the Secretary of Transportation (Pete Buttigeg) to require an airline to maintain service to any destination that airline served on March 20, 2020, if the airline accepts the COVID bailout money. This authority automatically expires on March 1, 2022. Provides $2 billion to transportation service companies that have lost at least 25% of their revenue due to COVID-19 that has fewer than 500 employees or a company with over 500 employees that hasn't received a bailout yet. The companies have to use at least 60% of the money to pay up to $100,000/yr per employee in salary as long as they don't furlough any more workers (they can spend the money on other things if all their workers are back and making their 2019 pay levels already). TITLE V - BANKING Provides $25 billion for rental assistance . The money will be given to the states and 90% of it needs to be used to pay rent, utilities, home energy costs, and other costs as determined by the Treasury Secretary. Under no circumstance can any household get payments for more than 15 months. The money will flow from the government directly to the landlord or utility provider (unless the landlord or utility provider refuses to accept the payment, which is the only circumstance during which the household will get the money). To be eligible you either have to have income below 50% of the area median income or one or more individuals in the home have been unemployed for at least 90 days. Landlords are allowed to apply on behalf of their tenants, with their permission and signature on the application. The funding expires December 31, 2021. Extends the eviction moratorium through January 31, 2021. Creates a new fund with $9 billion to give money to banks - by purchasing their stock - to lend out in low income and minority communities. The administration of these purchases can be outsourced to "any bank, savings association, trust company, security broker or dealer, asset manager, or investment advisor as a financial agent of the Federal Government." The law sets no limits on executive compensation, share buybacks, or dividend payments for the recipients of the bank's lending (the Secretary of the Treasury gets to make those rules). The authority for using this $9 billion is valid until 6 months after the emergency declared on March 13, 2020 is terminated. Extends the that exempted banks from relatively new reporting requirements on their credit losses until the end of the emergency or January 1, 2022, an extra year. Extends the that allows banks to avoid counting troubled loans as troubled on their balance sheets until 60 days after the emergency declared on March 13th ends or January 1, 2022, an extra year. This law also expands the eligibility to include insurance companies. TITLE VI - LABOR PROVISIONS Temporarily allows people who have already turned 25 to qualify for the Jobs Corps. TITLE VII - NUTRITION AND AGRICULTURE RELIEF From January 1, 2021 through June 30, 2021, food stamp beneficiaries will get 115% of the amount they received in June 2020. Money received from Federal unemployment payments - the money provided on top of state payments - will not be counted as income for the month the money was received or for the 9 months that follow for the purpose of determining food stamp eligibility. Provides over $11 billion for farmers and those that provide for local food systems such as farmers markers, restaurants, and schools. $1.5 billion will be used to purchase food for hungry Americans. $1 billion of this money can be used to pay up to 80% of the revenue losses of contract growers of livestock and poultry for the period beginning on January 1, 2020 (two months before COVID) through January 1, 2021. TITLE VIII - UNITED STATES POSTAL SERVICE Allows the postal service to keep the money it was loaned by the CARES Act TITLE IX - BROADBAND INTERNET ACCESS SERVICE Creates the "Emergency Broadband Benefit Program" funded with $3.2 billion, which allows households that qualify for some other COVID relief benefits can also get a monthly $50 discount on their internet service, or $100 if they are renting equipment, but only if their internet service provide elects to participate in the program. The FCC will reimburse the internet companies directly for the discounts. Companies that accept the money are not allowed to require an early termination fee of new customers who get service due to this benefit who then decide to cancel later. This is valid until 6 months after the end of the emergency is declared. TITLE X - MISCELLANEOUS Rescinds $429 billion out of the $500 billion that was provided the CARES Act to provide loans and invest in corporate bonds by the Federal Reserve. Terminates the authority created by the CARES Act for the Federal Reserve to make loans or purchase securities using the Main Street Lending Program, or the authorities granted to loan money to state and local governments. They can still make loans using the Term Asset-Back Securities Loan Facility. They are allowed to restructure and extend existing loans. Clarifies that the Federal Reserve is not in any way restricted from using authorities it already had before enactment of the CARES Act. TITLE I - NO SURPRISES ACT Starting on January 1, 2022, any health insurance company that provides "any benefits" in an emergency department can not require pre-authorization of those services or deny coverage because the emergency department is out of their network. If emergency services are provided out-of-network, there can not be any limits on coverage any more restrictive than what would be covered by an in-network emergency department and the out-of-pocket costs can't be more than they would be in-network. Out-of-pocket payments at an out-of-network emergency room must count towards in-network deductibles and out-of-pocket maximums. Emergency services include any care that happens in connection to the emergency visit, regardless of what department of the hospital provides the services. After the patient is stabilized, inpatient or outpatient stays in connection to that event are also covered. Loophole: Services are not covered if the patient is able to travel without medical transportation, is able to provide informed consent, and "other conditions" that will be determined by regulation. The prices to be paid by insurers will be based on the median price paid in the geographic area for similar services, and it will increase along with the consumer price index. In the case of a out-of-network doctor who works at an in-network hospital, if that doctor doesn't notify the patient that he/she is out-of-network, the health insurance company can't require the patient to pay any more out of pocket than they would pay if the doctor were in-network. Any cost-sharing payments must be applied to the in-network deductible and annual maximum out of pocket limits. This also applies to air ambulance providers. Health insurance companies are no longer allowed to require referrals for women to go to the gynecologist. Health insurance plans are still allowed to require gynecologists to notify the plan and/or the primary care doctor of their treatment decisions. To determine how much an insurance company will directly pay to an out-of-network provider, the provider has 30 days from receiving a payment or a denial of payment to start a negotiation process. If the negotiation fails, within four days, the provider or health insurance company can elect to start an independent dispute resolution. The Secretaries of Health and Human Services, Labor, and Treasury have until the end of 2021 to create this process by regulation. The regulation process will determine who will be certified to act as the dispute resolution judge, but it is not allowed to be an affiliate, subsidiary or trade group that represents a health insurance company or health care provider. The independent disputer settler will have 30 days to make the payment determination. The payment amounts can consider the comparable rates in the geographic region, the market share that provider controls in the region, the complexity of the patients case, and if either side made any effort to be in each other's network. They payment amounts can not consider the amount the provider usually chooses to charge or the rates usually paid by Medicare and Medicaid. The decisions will be binding and not subject to judicial review, unless there is evidence of fraud. The insurance company will have 30 days from the decision date to pay the bill. A lot of information about who uses this process and its results will be made public. The emergency departments and doctors can't send patients bills for anything more than their co-pay amounts. Out-of-network doctors working at in-network facilities are also prohibited from sending bills that are greater than the co-pay amounts. Out of network doctors at in-network facilities that provide services such as anesthesiology, radiology, and lab services can send bills to patients if the the patient makes an appointment to see them 72 hours or more in advance of their treatment and if the patient signs a written notice or email. The notice has to inform the patient that getting treated by the out-of-network doctor is optional and that they have the option to get treated by an in-network doctor, along with a list of in-network doctors available to provide the service. The notice also has to inform the patient that the amount they pay may not apply to their out-of-pocket limits or in-network deductible. The notice has to be dated and signed by the patient before they receive the services. Loophole: The notice has to have a "good faith estimated amount" that the provider "may" charge, but that that amount is not a contractual obligation. The states are given the authority to enforce these laws. If the state refuses to enforce them, the Secretary of Health and Human Services has the ability to enforce them, and issue fines to doctors (and specifically air ambulance operators) up to $10,000 per violation. There will be a process for submitting complaints to the Secretary of Health and Human Services, and the department has 60 days to respond. The doctor or air ambulance operator can avoid the fine by withdrawing the bill, reimbursing the patient for the difference between what they were charged and what they should have been charged, plus interest, within 30 days. Loophole: The law does give the Secretary of HHS the permission to create a "hardship exemption" to the fines. Establishes similar laws for air ambulance operators as are enacted for emergency rooms and out-of-network doctors working at in-network facilities. Patients with health insurance who receive air ambulance services can only be charged the in-network rate for a copay. Air ambulance companies are not allowed to bill patients with health insurance more than their co-pay amount. By January 1, 2022, health insurances have to issue new insurance identification cards which include "any deductible", "any out-of-pocket limit", and a telephone number and internet website that patients can use to find out who is in-network. Starting on January 1, 2022, before a patient receives a scheduled service, the health insurance company has to send them a physical notice or email - patient's choice - about whether they are schedule to see an in-network or out-of-network doctor. If they are scheduled for an in-network appointment, they have to tell the patients the contracted rate for the service. If they are scheduled for an out-of-network appointment, they have to tell the patient how to find an in-network doctor. The notice also has to include cost estimates, including an estimate submitted by the doctor, how much the health insurance company will probably pay, the cost of any co-pays, and how close the patient is to reaching any out-of-pocket limits. The notice must also include a disclaimer that these are only estimates. Starting on January 1, 2022, before a patient receives a scheduled service, the doctor needs to ask the patient if they have insurance, are covered bypass a government plan, or have no insurance. If the patient has insurance, they have to provide the health insurance company or the government with a "good faith estimate" of the expected charges with the billing codes for the expected services. If the person does not have insurance, the estimate has to be given directly to the patient. The Secretary of Health and Human Services will have to create a process by January 1, 2022 for uninsured patients who are charged more than their estimates to have their bill determined by an independent dispute resolution authority. If a health insurance plan ends its contract with a patient's doctor, the health insurance company has to notify the patient and give the patient the opportunity to request and be granted 90 days of keeping the co-payment structure they had while the doctor was in-network. Health insurance companies will have to offer patients - via telephone and internet - a tool that allows them to compare the co-pays they would be responsible for if they received a service from each of their in-network providers. Requires health insurance companies to accurately maintain their in-network provider database. If the patient gets information about a doctor from an outdated database, or if the patient's requests for information go unanswered, the insurance company must charge the patient in-network copays, but the deductible will be applied to the out-of-network maximum limit. TITLE II - TRANSPARENCY Health insurance companies will be prohibited from contractually preventing doctors from revealing their pricing agreements to referring doctors, the patient, the patient's employer, or people eligible to be a part of that health insurance plan. Restrictions can be placed upon what information is made public. Starting at the beginning of 2022, health insurance companies will annually submit a report to the government about the 50 most common prescription drugs they pay for, the 50 most expensive prescription drugs, and the 50 prescription drugs with the greatest increase in price. The report also has to break down the costs of other categories of care, such as hospital visits, provider costs, and drug costs. They will also have to report on the average amount monthly premiums they receive from employers and patients. TITLE XIV - COVID-19 CONSUMER PROTECTION ACT For the duration of the public emergency, it will be illegal for "any person, partnership, or corporation" to deceive anyone in association with a COVID-19 treatment, cure, prevention, or diagnosis or a government benefit related to COVID-19. This will be enforced by the Federal Trade Commission and violators can be fined Articles/Documents Article: , By Anna Wilde Mathews, Tom McGinty and Melanie Evans, The Wall Street Journal, February 11, 2021 Article: , By Richard Rubin, The Wall Street Journal, February 6, 2021 Article: , By KFF.org, February 4, 2021 Article: , By Brandon Brockmyer and Ryan Summers, Pogo, February 3, 2021 Article: , By Katherine Khashimova Long, Seattle Times, February 2, 2021 Article: , By Ellie Kaverman and Andrew Stettner, The Century Foundation, February 2, 2021 Article: &firstPage=true), By Jody Godoy, Westlaw Today, January 20, 2021 Article: , By Liam Vaughan and Gavin Finch, The Guardian, January 18, 2021 Article: , By White & Case LLP, Lexology, January 7, 2021 News Release: , Department of Labor, December 30, 2020 Document: , By Congressional Budget Office, December 27, 2020 Article: , By Rachel Lilienthal Stark, National Law Review, December 22, 2020 Article: , By Julie Appleby, npr, December 22, 2020 Article: , By Alexander Bolton, The Hill, December 19, 2020 Article: , By Alexander Bolton, The Hill, December 17, 2020 Article: , By Steve Liesman, CNBC, December 8, 2020 Article: , By Robert Channick, Chicago Tribune, May 21, 2020 Article: , By Tim Ott, Biography, September 28, 2020 Sound Clip Sources News Clip: , Today, February 11, 2021 Hearing: , House Committee on Energy and Commerce: Subcommittee on Consumer Protection and Commerce, February 4, 2021 Witnesses: Executive Director of Distinguished Fellow at the Institute for Technology Law and Policy at Georgetown Law School Former Director of Consumer Protection at the Federal Trade Commission She served at the FTC for 26 years Transcript: 44:40 Bonnie Patten: The list of deceptively marketed products and services exploiting this pandemic is extensive. CBD products marketed to military veterans as a Coronavirus treatment, bleach advertised as a liquid cure all, Wellness Centers targeting first responders, with IV vitamin drips to protect against COVID-19. Amazon and eBay sellers falsely claiming that their PPE FDA approved. Hand sanitizer marketed is protecting for 24 hours against COVID-19. Alleged immune immunity boosting supplements targeting children. Colloidal Silver solutions advertised as having the ability to kill the virus from within. Toothpaste and teeth whitening products claiming to prevent COVID-19 and Sham wellness kits targeting seniors. Unfortunately, the deception does not stop with outrageous health claims. Many are exploiting the economic desperation wrought by this pandemic. Multi level marketing companies claiming people can earn full time pay working part time. Lending companies deceptively using the cares act to exploit college students. Investment scams claiming to have patented COVID cures and financial entities pretending to be SBA authorized lenders to lure in small businesses struggling to keep their workers employed. 46:15 Bonnie Patten: And to make matters worse, the agency primarily charged with policing these deceptive acts, the FTC, is now at risk of losing a mainstay of its enforcement authority and the ability to make victims whole under Section 13-b. Because 13-b does not specifically say anything about equitable relief when a permanent injunction is issued, the Supreme Court is now deciding the remedial scope, if any of 13-b in the case AMG vs FTC. AMG was a payday lending scheme that extracted money from people in desperate circumstances and in its appeal, the company does not dispute that it violated the law. Instead, it argues that the $1.3 billion it's stole should be it's to keep. AMG asserts that it was never Congress's intention for the FTC to return money to victims of fraud under 13-b. Quite to the contrary. AMG argues that this legislative body fully endorsed the notion that wrongdoers should pocket the money they've illegally taken when it drafted 13-b. If the Supreme Court rules in AMG's favor, and this Congress does not act to empower the FTC to seek restitution under 13-b, then the deceptive practices I have enumerated will only multiply. 1:17:40 Jessica Rich: The new law covers a huge amount of scams. It's very broad as to COVID scams. So if a company engages in any of that activity, the FTC can pursue civil penalties and so just as Miss Patton just said, it's very important for deterrence to make it painful for fraudsters to rip off consumers. 1:18:20 Rep. Frank Pallone (NJ): But now that the FTC has this authority to find companies who've committed fraud and scams related to the pandemic under this new law, why is it still important to ensure that the FTC 13 b authority is preserved? Why is that so important? Bonnie Patten: COVID scams are terrible, but they're one of many frauds that the FTC has to fight all year long in and out of a pandemic. So in many of those cases, the FTC doesn't have civil penalty authority, and its rigorous authority is under threat. So it's a much broader problem that goes beyond the COVID scams that are occurring here. And so it still needs to be fixed. 2:23:25 Rep. Darren Soto (FL): Is this being sufficiently used already by the FTC? Do you anticipate gaps in all this law realizing it just was passed? Bonnie Patten: To my knowledge, the FTC has not yet used that act. But that's the only information I know, that there's no public on their website. It does have gaps. It does. You cannot target work from home scams using this, because it's really focused primarily on government benefits, scams and healthcare scams. But what I would say is that, while it's absolutely critical to have an act like this, at this time, during the pandemic, I would warn you that it doesn't provide for coverage for the next disaster. For the next earthquake for the next fire, what have you, there are unfortunately will always be a segment of our population that is in devastating events. And so I think that legislation is necessary that covers all such events and not just focused on the pandemic. Hearing: , Congressional Oversight Commission, December 10, 2020 Witnesses: Eric Rosengren - President and Chief Executive Officer of the Federal Reserve Bank of Boston Gwen Mills - Secretary Treasurer of Unite Here Lauren Anderson - Senior Vice President & Associate General Counsel of the Bank Policy Institute Transcript: 03:20 Bharat Ramamurti: Four months ago, Congress gave the Treasury Department half a trillion dollars to stabilize the economy. The Treasury quickly pledged 75 billion of those dollars to the Federal Reserve's Main Street lending program for small and mid sized companies. After taking three months to set up the program, the Fed has now been operating it for about a month. In that time, it has supported only 18 loans for a total of $104 million. That is 0.017% of the $600 billion lending capacity that the Fed touted for the program in April. 16:07 Eric Rosengren: This facility is very different than some of the other traditional kinds of facilities that central banks operate during a time of crisis. So most of our facilities operate through markets, market securities, you can purchase them very easily through the market. They clear usually in a couple days depending on the security. So it's relatively easy to quickly purchase a large number of securities and hold those securities over time. This facility is a facility we didn't have during the financial crisis, and really tries to get to a different segment of the population, which is those businesses that are bigger than the PPP program was designed for and smaller than what the corporate facilities are designed for. Session: , Senate, July 29, 2020 Session: , Senate, July 28, 2020 News Clip: , CBS News, July 28, 2020 Hearing: , Committee on Energy and Commerce: Subcommittee on Health, June 12, 2019 Witnesses: Sonji Wilkes: Patient Advocate Sherif Zaafran, MD: Chair of Physicians for Fair Coverage Rick Sherlock: President and CEO of Association of Air Medical Services James Gelfand: Senior Vice President of Health Policy at The ERISA Industry Committee Thomas Nickels: Executive Vice President of the American Hospital Association Jeanette Thornton: Senior Vice President of Proiduct, Employer, and Commercial Policy at Americas’ Health Insurance Plans Claire McAndrew: Director of Campaigns and Partnerships at Families USA Vidor E. Friedman, MD: President of American College of Emergency Physicians Transcript: 51:50 CEO Rick Sherlock: $10,199 was the median cost of providing a helicopter transport. While Medicare paid $5,998, Medicaid paid $3,463 and the uninsured paid $354. This results in an ongoing imbalance between actual costs and government reimbursement and is the single biggest factor in increasing costs. 53:45 Senior VP James Gelfand: We're focused on three scenarios in which patients end up with big bills they couldn't see coming or avoid. Number one, a patient receives care at an in-network facility, but is treated by an out of network provider. Number two, a patient requires emergency care, but the provider's facility or transportation are out of network. And number three, a patient is transferred or handed off without sufficient information or alternatives. It's usually not the providers you're planning to see. It's anesthesiologists, radiologists, pathologists, or emergency providers or transport or an unexpected trip to the NICU. Many work for outsourced medical staffing firms that have adopted a scam strategy of staying out of networks, practicing at in-network facilities and surprise billing patients. It's deeply concerning, but the problem is narrowly defined and therefore we can fix it. Hearing: , House Committee on Education and Labor, April 2, 2019 Witnesses: Christen Linke Young: Fellow at USC-Brookings Schaeffer Initiative on Health Policy Ilyse Schuman: Senior Vice President for Health Policy at American Benefits Council Frederick Isasi, Executive Director at Families USA Professor Jack Hoadley: Research Professor Emeritus at Georgetown University’s Health Policy Institute Transcript: 33:50 Frederick Isasi: Take for example, one significant driver of this problem. The movement of hospitals to offload sapping requirements for their emergency departments to third party management companies. These hospitals very often make no requirements of these companies to ensure the staffing of the ED fit within the insurance networks that the hospitals have agreed to. As a result, a patient who does their homework ahead of time and rightly thinks they're going to an in network hospital, received services from an out of network physician and a surprise medical bill follows. 43:30 Chairman Frederica Wilson (FL): Under current law, who is responsible for making sure that a doctor or a hospital is in-network? Is it the doctor, the insurance company or the patient themselves? Frederick Isasi: Uh, chairman Wilson, thank you for the question. To be very clear, it is the patient themselves that has a responsibility and these negotiations are very complex. These are some of the most important and intense negotiations in the healthcare sector between a payer and a provider. There is absolutely no visibility for a consumer to understand what's going on there. And so the notion that a consumer would walk into an emergency department and know, for example, that their doctor was out of network because that hospital could not reach agreement on an in-network provider for the ED is absurd, right? There's no way they would ever know that. And similarly, if you walk in and you received surgery and it turns out your anesthesiologist isn't in-network, there's no way for the consumer to know that. Um, and I would like to say there's some discussion about transparency and creating, you know, sort of provider directories. We've tried to do that in many instances. And what we know is that right now the healthcare sector has no real way to provide real actual insight to consumers about who's in-network, and who's out of network. I would-probably everybody in this room has tried at some point to figure out if a doctor's in-network and out of network and as we know that system doesn't work. So this idea that consumers can do research and find out what's happened behind the scenes in these very intensive negotiations is absurd and it doesn't work. 46:30 Professor Jack Hoadley: Provider directories can be notoriously inaccurate. One of the things that, even if they are accurate, that I've seen in my own family is you may be enrolled in Blue Cross-You ask your physician, "are they participating in Blue Cross? They say "yes", but it turns out Blue Cross has a variety of different networks. This would be true of any insurance company, and so you know, you may be in this one particular flavor of the Blue Cross plan and your provider may not participate in that particular network. 1:01:25 Rep. Phil Roe (TN): I've had my name in networks that I wasn't in. That you-that you use, and many of those unscrupulous networks, will use that too to get people to sign up because this doctor, my doctor is in there when you're really not. 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CD227: Coronabus Health Care | Congressional Dish podcast - Listen or read transcript on Metacast
