When Rep. Katie Porter's (D-Calif.) appendix burst last year, she unknowingly received treatment from an out-of-network surgeon at an in-network hospital, leaving her responsible for almost $3,000 in out-of-pocket costs, Jennifer Haberkorn reports for the Los Angeles Times. Now, Porter is sharing her story with Congress as part of the government's push to develop legislation to address the issue.

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In-network hospital, out-of-network surgeon

Weeks before she was elected to represent Irvine, California, in Congress, Porter's appendix burst. Porter asked her campaign manager to take her to Hoag Hospital because she knew their ED was in-network for her insurance. At the hospital, Porter underwent an appendectomy and spent an additional five days in recovery.

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Porter paid a $250 copayment for the hospital visit, and her insurance covered about $55,000 worth of care.

But a few weeks later, Porter received a $3,231 bill. Even though Hoag was in her insurance plan's network, upon receiving the bill, Porter found out that the surgeon who performed the operation was not. As such, Porter owed $2,800 out of pocket for the surgery, Haberkorn reports.

Porter, said her experience is not unique. According to estimates, more than 20% of ED visits end in surprise bills. "It's not a special story because I'm a member of Congress. It's actually that this is such an ordinary experience," she said. "[W]e're trying to encourage Americans to buy insurance in the face of higher premiums. … To then not have the insurance system working to protect people from unexpected problems is a real problem."

Surprise billing legislation expected in Congress as soon as this week

Porter on Tuesday shared her experience with Congress at one of several hearings on surprise billing legislation scheduled to take place over the next few weeks, Haberkorn reports.

The issue has garnered attention from both Republican and Democratic lawmakers, and Haberkorn reports Congress is expected to soon release a plan to curb surprise billing at the federal level.

For instance, as soon as this week, Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are expected to release a preliminary version of a health care package, according to Haberkorn.

Other legislation ideas that are floating in Congress include a proposal that requires out-of-network physicians in certain emergency situations be paid in-network rates, Haberkorn reports. Some lawmakers are considering legislation that would establish an arbitration process that would settle billing disputes between the insurer and the provider, as well as legislation that would cap out-of-network bills at a set rate, Haberkorn reports.

President Trump, who earlier this month said surprise billing "must end," has suggested that patients receive one bill per ED trip, Haberkorn reports. According to Haberkorn, his administration hasn't endorsed the arbitration approach.

If Congress can get behind one proposal, a bipartisan-backed legislation addressing the phenomenon could land on Trump's desk later this year, Haberkorn reports (Haberkorn, Los Angeles Times, 5/21).

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