Congress Searching for Accord on 'Surprise' Medical Bills 

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Jun 13 2019

A congressional hearing on how to stamp out surprise medical bills put the differences between competing factions of the health care industry on full display June 12. While the issue has drawn an unusual amount of bipartisan cooperation and agreement that patients should be held harmless, the central challenge for lawmakers remains how to agree on a process for settling payment disputes between health plans and medical providers.

Those battle lines were reinforced in testimony before the Subcommittee on Health of the Committee on Energy and Commerce at a hearing titled “No More Surprises: Protecting Patients from Surprise Medical Bills.”

Medical provider groups laid some of the blame for surprise bills on insufficient provider networks and said disputes should be handled by independent arbiters. Employers and insurer groups strongly oppose arbitration and are advocating for provider reimbursements tied to in-network rates.

The ERISA Industry Committee’s James Gelfand outlined large employers’ perspective in his testimony and praised draft legislation from committee leaders, the No Surprises Act. Gelfand said the proposal would create “a reasonable, market-based benchmark” that would provide “certainty to plans, plan sponsors, patients, and providers.”

This draft bill would settle billing disputes by tying the minimum payment to the median in-network rate for the same services, and require that patients receive notice and give their consent before an out-of-network provider delivers scheduled care. Patients not given advance notice would pay only the change they would have paid to an in-network provider.

More proposals, however – some of which embrace arbitration - are already getting serious attention in Congress, and key senators from both parties hope to get legislation targeting surprise medical bills and healthcare costs to President Donald Trump by July.

See more on the state-of-play in this GRIST from Mercer’s Law & Policy Group.

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