House Looks At Surprise Billing Proposals

By Susan Rupe InsuranceNewsNet

Surprise medical billing is a source of anger and frustration to consumers. Now, two House committees are releasing their proposals to protect consumers from the practice.

The House Ways and Means Committee and the House Education and Labor Committee released their plans. Both committees plan to vote on their proposals this week.

The Ways and Means Committee bill would protect patients from surprise bills and use arbitration to determine how much a health insurer pays the doctor, although the arbiter must consider the median rate for that service in determining how much the insurer will pay. The Federation of American Hospitals endorsed this proposal, which is more favorable to hospitals worried about payment cuts.

The Ways and Means Committee draft bill proposes that when a patient receives a surprise bill for out-of-network medical care at an in-network facility or when receiving emergency care, providers and insurers would negotiate payment through a dispute resolution process.

Both sides would have 30 days to negotiate payment on their own. If the sides still disagree, either party could begin a 30-day arbitration process, in which both sides would propose their last, best offer to an independent mediator.

The Education and Labor Committee bill would set the payment rate based on the median rate, with an option for arbitration on high-cost bills. Families USA backs this approach, saying it does more to lower health care costs.

Under this proposal, insurers would pay out-of-network providers the median in-network rate for that geographic area for amounts up to $750. For larger amounts, either side could request an arbitration process. When a patient receives a surprise bill from an air ambulance provider, the threshold would be $25,000.

President Donald Trump and lawmakers from both parties have stated they want to protect consumers from surprise out-of-network medical bills. But they have disagreed about how they want to accomplish this. Lawmakers hope to include surprise billing legislation in a package that would extend funding for public health programs that expire on May 22.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.