Surprise medical billing occurs when patients are unknowingly treated by health care providers outside of their health plan’s contracted network.
Notably, the committee’s bipartisan draft proposal does not include arbitration to resolve pay disputes between hospitals, physicians, and insurers. Rather, insurers would pay the median rate the plan would pay to in-network providers in the same geographic market.
However, lawmakers signaled that they would be open to an arbitration approach. Rep. Raul Ruiz (D-CA) advocated for his own bipartisan proposal (not yet introduced) which will include arbitration. Reps. Doris Matsui (D-CA) and John Shimkus (R-IL) questioned using a benchmark rate to resolve surprise bills and dismissed concerns that arbitration would raise costs for employers and insurers.
HR Policy is part of a new coalition urging Congress to pass legislation that addresses the problem by prohibiting balance billing when patients inadvertently see out-of-network providers, creating a fair and reasonable payment benchmark for out-of-network care in those situations, and avoiding a costly, bureaucratic arbitration processes.
Outlook: It is not yet clear whether we will see movement on surprise billing legislation this summer. Senate HELP Committee Chair Lamar Alexander (R-TN) announced that he will hold a hearing on his bipartisan draft bill to reduce health care costs—which addresses surprise billing among other issues—next week. The HELP bill proposes arbitration as one of three approaches to resolve surprise bills.
