EXAMINING SURPRISE BILLING: PROTECTING PATIENTS FROM FINANCIAL PAIN HEARING BEFORE THE SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS COMMITTEE ON EDUCATION AND LABOR U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED SIXTEENTH CONGRESS FIRST SESSION HEARING HELD IN WASHINGTON, DC, APRIL 2, 2019 Serial No. 116–14 Printed for the use of the Committee on Education and Labor ( Available via the World Wide Web: www.govinfo.gov or Committee address: https://edlabor.house.gov U.S. GOVERNMENT PUBLISHING OFFICE 36–589PDF WASHINGTON : 2019 VerDate Mar 15 2010 11:59 Nov 19, 2019 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 C:\USERS\NWILLIAMS\ONEDRIVE - US HOUSE OF REPRESENTATIVES\DESKTOP\3658 EDL-011-D with DISTILLER COMMITTEE ON EDUCATION AND LABOR ROBERT C. ‘‘BOBBY’’ SCOTT, Virginia, Chairman Susan A. Davis, California Virginia Foxx, North Carolina, Rau´ l M. Grijalva, Arizona Ranking Member Joe Courtney, Connecticut David P. Roe, Tennessee Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan Northern Mariana Islands Brett Guthrie, Kentucky Frederica S. Wilson, Florida Bradley Byrne, Alabama Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin Mark Takano, California Elise M. Stefanik, New York Alma S. Adams, North Carolina Rick W. Allen, Georgia Mark DeSaulnier, California Francis Rooney, Florida Donald Norcross, New Jersey Lloyd Smucker, Pennsylvania Pramila Jayapal, Washington Jim Banks, Indiana Joseph D. Morelle, New York Mark Walker, North Carolina Susan Wild, Pennsylvania James Comer, Kentucky Josh Harder, California Ben Cline, Virginia Lucy McBath, Georgia Russ Fulcher, Idaho Kim Schrier, Washington Van Taylor, Texas Lauren Underwood, Illinois Steve Watkins, Kansas Jahana Hayes, Connecticut Ron Wright, Texas Donna E. Shalala, Florida Daniel Meuser, Pennsylvania Andy Levin, Michigan* William R. Timmons, IV, South Carolina Ilhan Omar, Minnesota Dusty Johnson, South Dakota David J. Trone, Maryland Haley M. Stevens, Michigan Susie Lee, Nevada Lori Trahan, Massachusetts Joaquin Castro, Texas * Vice-Chair Ve´ronique Pluviose, Staff Director Brandon Renz, Minority Staff Director ---- SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS FREDERICA S. WILSON, Florida, Chairwoman Donald Norcross, New Jersey Tim Walberg, Michigan Joseph D. Morelle, New York Ranking Member Susan Wild, Pennsylvania David P. Roe, Tennessee Lucy McBath, Georgia Rick W. Allen, Georgia Lauren Underwood, Illinois Francis Rooney, Florida Haley M. Stevens, Michigan Jim Banks, Indiana Joe Courtney, Connecticut Russ Fulcher, Idaho Marcia L. Fudge, Ohio Van Taylor, Texas Josh Harder, California Steve C. Watkins, Jr., Kansas Donna E. Shalala, Florida Ron Wright, Texas Andy Levin, Michigan Dan Meuser, Pennsylvania Lori Trahan, Massachusetts Dusty Johnson, South Dakota (VACANT) (II) VerDate Mar 15 2010 11:59 Nov 19, 2019 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 C:\USERS\NWILLIAMS\ONEDRIVE - US HOUSE OF REPRESENTATIVES\DESKTOP\3658 EDL-011-D with DISTILLER CONTENTS Page Hearing held on April 2, 2019 ................................................................................ 1 Statement of Members: Walberg, Hon. Tim, Ranking Member, Subcommittee on Health, Employ- ment, Labor, and Pensions ........................................................................... 4 Prepared statement of ............................................................................... 6 Wilson, Hon. Frederica S., Chairwoman, Subcommittee on Health, Em- ployment, Labor, and Pensions .................................................................... 1 Prepared statement of ............................................................................... 3 Statement of Witnesses: Hoadley, Dr. Jack, Ph.D., Research Professor Emeritus Health Policy Institute, McCourt School of Public Policy, Georgetown University ........ 62 Prepared statement of ............................................................................... 65 Isasi, Mr. Frederick, J.D., MPH, Executive Director, Families USA ........... 51 Prepared statement of ............................................................................... 53 Schuman, Ms. Ilyse, Senior Vice President, Health Policy, American Ben- efits Council ................................................................................................... 35 Prepared statement of ............................................................................... 37 Young, Ms. Christen Linke, J.D. Fellow, USC-Brookings Schaeffer Initia- tive on Health Policy .................................................................................... 8 Prepared statement of ............................................................................... 10 Additional Submissions: Foxx, Hon. Virginia, a Representative in Congress from the State of North Carolina: Prepared statement from the American Medical Association (AMA) ... 101 Prepared statement from AHIP ............................................................... 107 Letter dated April 2, 2019, from the American Heart Association ....... 117 Letter dated April 2, 2019, from the American Hospital Association, American Medical Association, Federation of American Hospitals ... 120 Morelle, Hon. Joseph D., a Representative in Congress from the State of New York: Letter dated April 2, 2019, from Hanys............................................... 122, 124 Scott, Hon. Robert C. ‘‘Bobby’’, a Representative in Congress from the State of Virginia: Letter dated April 1, 2019 from the American College of Emergency Physicians ............................................................................................... 126 Letter dated April 2, 2019 ........................................................................ 133 Prepared statement from the American Medical Association (AMA) ... 137 Prepared statement from American Association of Nurse Anes- thetists .................................................................................................... 143 Prepared statement from American Academy of Family Physicians .... 147 Prepared statement from the American Hospital Association .............. 149 Letter dated February 20, 2019 ............................................................... 155 Prepared statement from the College of American Pathologists ........... 157 Letter dated April 9, 2019 from Community Catalyst ........................... 161 Mr Walberg: Letter dated April 2, 2019 ........................................................................ 166 Questions submitted for the record by: Fulcher, Hon. Russ, a Representative in Congress from the State of Idaho ................................................................................................... 178 Norcross, Hon. Donald, a Representative in Congress from the State of New Jersey ......................................................................................... 174 Roe, Hon. David P., a Representative in Congress from the State of Tennessee ....................................................................... 171, 174, 177, 180 (III) VerDate Mar 15 2010 11:59 Nov 19, 2019 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 C:\USERS\NWILLIAMS\ONEDRIVE - US HOUSE OF REPRESENTATIVES\DESKTOP\3658 EDL-011-D with DISTILLER IV Page Additional Submissions—Continued Questions submitted for the record by—Continued Stevens, Hon. Haley M., a Representative in Congress from the State of Michigan ......................................................................................... 171, 180 Responses to questions submitted for the record by: Mr. Isasi ..................................................................................................... 182 Mr. Hoadley ............................................................................................... 191 Ms. Schuman ............................................................................................. 194 Ms. Young .................................................................................................. 201 VerDate Mar 15 2010 11:59 Nov 19, 2019 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 C:\USERS\NWILLIAMS\ONEDRIVE - US HOUSE OF REPRESENTATIVES\DESKTOP\3658 EDL-011-D with DISTILLER EXAMINING SURPRISE BILLING: PROTECTING PATIENTS FROM FINANCIAL PAIN Tuesday, April 2, 2019 House of Representatives Committee on Education and Labor Subcommittee on Health, Employment, Labor, and Pensions Washington, DC. The subcommittee met, pursuant to notice, at 10:15 a.m., in room 2175, Rayburn House Office Building. Hon. Frederica S. Wilson [chairwoman of the committee] presiding. Present: Representatives Wilson, Norcross, Morelle, Wild, McBath, Underwood, Stevens, Courtney, Shalala, Levin, Trahan, Walberg, Roe, Allen, Banks, Taylor, Watkins, Wright, Meuser, and Johnson. Also present: Representatives Scott and Foxx. Staff present: Nekea Brown, Deputy Clerk; Ilana Brunner, Gen- eral Counsel Health and Labor; Emma Eatman, Press Aide; Daniel Foster, Health and Labor Counsel; Mishawn Freeman, Staff Assist- ant; Christian Haines, General Counsel Education; Stephanie Lalle, Deputy Communications Director; Andre Lindsay, Staff As- sistant; Kota Mitzutani, Staff Writer; Max Moore, Office Aide; Merrick Nelson, Digital Manager; Veronique Pluviose, Staff Direc- tor; Banyon Vassar, Deputy Director of Information Technology; Marty Boughton, Minority Press Secretary; Courtney Butcher, Mi- nority Coalitions and Members Services Coordinator; Rob Green, Minority Director of Workforce Policy; Sarah Martin, Minority