Bill to Protect Citizens from Surprise Medical Bills Unveiled by Bipartisan Coalition

May 24, 2019 by Dan McCue

A bipartisan coalition of House members on Thursday released their outline of the Protecting People from Surprise Medical Bills Act, legislation intended to protect patients from unfair and expensive surprise medical bills.

“For too many middle-class families, receiving an unexpected and very expensive bill from an out-of-network provider is devastating and can lead to severe anxiety, depression, and financial ruin. This must end,” said Dr. Raul Ruiz, D-Calif., one of the lawmakers behind the draft plan.

“That’s why I will soon introduce the bipartisan Protecting People from Surprise Medical Bills Act, legislation that will ban these bills and keep families out of the middle by using a fair, evidence-based, independent, and neutral arbitration system to resolve payment disputes between insurers and providers,” he said.  “As an emergency doctor, patients come first and must be protected.

“I look forward to working as a bipartisan team to get this critical legislation signed into law,” he said.

In addition to Ruiz, the team consists of Dr. Phil Roe, R-Tenn., Joseph Morelle, D-N.Y., Van Taylor, R-Texas, Dr. Ami Bera, M.D., D-Calif., Dr. Larry Bucshon, M.D., R-Ind., Donna Shalala, D-Fla., and Brad Wenstrup, R-Ohio.

They expect to introduce a finalized version of the legislation in coming weeks.

Surprise billing impacts hard-working families across the nation. Currently, patients with private insurance expect that visits to in-network hospitals for medically necessary care will be covered by their insurance.

However, patients sometimes receive surprise bills for thousands of dollars from the emergency department or out-of-network providers based at in-network hospitals.

These surprise bills result from disputes between providers and insurance companies. When insurers and providers cannot agree on the cost of care, patients are often on the hook for tens of thousands of dollars in unexpected bills. In 29 states and the District of Columbia, there are no legal protections designed to protect patients from surprise bills.

Under the Protecting People from Surprise Medical Bills Act, the practice of balance billing would be banned. Patients would be left out of the middle and are not required to play any part in resolving payment disputes.

The Act takes a proven approach to protecting patients from surprise bills by adopting an arbitration model.

Under this model – similar to the one adopted by New York State in 2015 – if providers and insurers cannot agree on a payment rate, they can engage in an independent dispute resolution process.

Under IDR, insurers and out-of-network providers each identify a cost for the patient’s care, and a neutral arbiter chooses the fairer price. This model creates an incentive for both parties to choose reasonable numbers to cover the cost of treatment.

According to a 2018 study, out-of-network bills in New York declined 34 percent just three years after the state passed arbitration legislation.

Like Ruiz, Representative Roe, a medical doctor, believes that “for too long, these bills have negatively impacted patients and families across our nation causing financial stress when working out how to pay for costly, unexpected bills.

“The legislative principles we have laid out will rely on reasonable payment metrics and a system of arbitration between medical providers and insurers to compensate providers for care, instead of leaving patients on the hook for costly surprise bills,” he said.

“With around 180 million Americans receiving their health care coverage from an employer in a large group plan controlled by the Employee Retirement Income Security Act, it is time they have some peace of mind that a surprise bill won’t financially wipe them out,” Roe continued. “Similar laws have proven successful in New York and Maryland for state-based plans, and I am hopeful these principles will soon lead to legislation that will be the solution we need to help protect patients.”

Representative Morelle said when a medical emergency arises, the last thing a patient should be worried about is whether they’ll receive a massive bill in the mail they can’t afford to pay later on.

“That is why we need to eliminate surprise billing and create a more affordable, transparent healthcare delivery system that puts patients first,” the New York Democrat said. “I am delighted to partner with my colleagues to advance this critical legislation, modeled after the successful adoption of similar measures in New York State, and bring peace of mind to families everywhere.”

One of the keys to garnering such strong bipartisan support for even the draft version of the legislation is its inclusion of an easily understood and independent dispute resolution process.

“Instead of picking winners and losers, I support this bipartisan proposal that offers an independent dispute resolution process that is mediated by an arbiter,” said Dr. Bucshon, an Indiana Republican.

“Access to life saving care is critical for all Americans and it should not come with lifelong penalties,” he said.

“We’ve learned from a number of states that have already passed surprise medical bill legislation, and now it’s time to take the lessons learned and protect all Americans from surprise medical bills,” Representative Shalala said. “No American should be faced with a financially crippling bill from an out-of-network provider. I’m pleased to join my colleagues in proposing this legislation to finally end surprise medical bills. I look forward to this legislation making its way to the President’s desk.”

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