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New bill aims to curtail surprise medical bills for sexual assault survivors

Federal law requires forensic exams to be free for victims of sexual violence, but many patients still receive large bills.
Sexual assault evidence collection kits used at the Nancy J. Cotterman Center in Fort Lauderdale, Fla., on June 18, 2022.
Sexual assault evidence collection kits used at the Nancy J. Cotterman Center in Fort Lauderdale, Fla., on June 18.Carline Jean / South Florida Sun Sentinel via Getty Images file

A bill introduced in the House of Representatives would require private health insurance to cover forensic exams for sexual assault survivors in full.

The legislation came after research published in the New England Journal of Medicine showed that nearly 18,000 out of 113,000 emergency visits related to sexual violence in 2019 resulted in out-of-pocket costs for the survivors. The average cost was $3,551 per person.

The Violence Against Women Act (VAMA), a federal law enacted in 1994, stipulates that sexual assault victims cannot be charged for a forensic exam, which involves treating people for immediate injuries and collecting evidence needed for an investigation such as samples of blood, urine, skin or hair.

But some patients are charged anyway, either because of hospital error or because the exam included medical services that are not covered under the VAMA.

For a state to qualify for grant funding under the law, they must agree to cover the full out-of-pocket cost of forensic medical exams. States can use that funding to pay for exams performed by a specially trained clinician like a sexual assault nurse examiner, or SANE, but must find other funding sources if a provider does not meet that criteria.

The new bill was introduced by Reps. Linda T. Sánchez, D-Calif.; Gwen Moore, D-Wis.; and Carol Miller, R-W.Va. It would give the departments of Labor, the Treasury, and Health and Human Services the authority to designate types of providers beyond SANEs who'd be eligible to give forensic exams that would be fully covered by private insurance, starting in 2025. The lawmakers' hope is that survivors with private insurance would not get billed for an exam, regardless of where it's performed.

If a victim receives a bill for costs the state is legally responsible for under the Violence Against Women Act, the proposed law would also require private insurers to let survivors know how to seek proper reimbursement.

Additionally, the bill, called the No Surprises for Survivors Act, stipulates that forensic medical exams should be considered an emergency service under the No Surprises Act, a 2020 law that protects people with private insurance from receiving surprise medical bills for certain forms of emergency care.

"This legislation is needed because too many survivors, grappling with trauma, also become burdened with the cost of a forensic medical exam — even though they shouldn’t be," Moore said in a statement.

March study published by KFF, a nonprofit health-focused think tank formerly known as the Kaiser Family Foundation, found that two-thirds of privately insured women who likely received a forensic exam after a sexual assault from 2016 to 2018 were charged out-of-pocket for at least one standard service included in that exam. The women spent $347, on average.

"Unfortunately, many survivors still find themselves stuck with unexpected charges," Sánchez said in a statement. "Our bipartisan bill will help right that wrong."

The bill, however, would not have an effect on the additional medical services that some survivors get charged for as part of an emergency visit, such as pregnancy tests, emergency contraception, or testing or treatment for sexually transmitted infections. Only some states require that such services be free. The KFF report found that 17 states cover the costs of STI testing, 15 cover preventative HIV treatment and 11 cover emergency contraception.

CLARIFICATION (Oct. 26, 10:30 a.m. ET): This article has been updated to clarify the reasons why women might get charged for hospital exams after a sexual assault.