Two rival House bills to end surprise billing have again been proposed and are generating both provider support and opposition.
The House Committee on Ways and Means released the Consumer Protections Against Surprise Medical Bills Act of 2020, a measure that if passed, would not allow patients to be charged more than the in-network cost-sharing amount.
Patients would receive an Advance Explanation of Benefits -- "a true and honest cost estimate, lawmakers said " -- that would describe which provider would deliver their treatment, the cost of services, and provider network status.
The bill prohibits providers from balance billing, a practice already illegal in some states. Insurer and provider disputes over out-of-network payments would be settled through arbitration.
The Federation of American Hospitals said it likes this approach because it settles payment without rate setting.
Hospitals were against previous proposed surprise billing legislation that called for a benchmark payment setting rate.
A second, House Committee on Education and Labor bill is similar to a proposal from the House Energy and Commerce Committee released in December.
It sets the payment rate based on the median rate with an option for arbitration on high-cost bills.
WHY THIS MATTERS
The Association of American Surgeons and Physicians said the Ways and Means legislation would lead to even narrower networks and managed-care rationing methods that would increase the power of hospitals and insurers to control the practice of medicine, with their financial interest in reducing their own spending as the first priority, according to Dr. Jane M. Orient, executive director of the AASP.
"The proposal from the Ways & Means Committee relies solely on arbitration – essentially providing a handout to the very players who started this problem and continue to profit off American families at their most vulnerable moments," Orient said.
Most provider organizations which voiced an opinion support the Ways and Means solution.
Dr. Maryanne C. Bombaugh, president of the Massachusetts Medical Society, said, "The Ways and Means bill, importantly, provides strong patient protections, including shielding patients from receiving these unavoidable medical bills. At the same time, this approach incentivizes insurers and physicians to work in good faith to resolve the surprise bill.
The American College of Emergency Physicians supports the Ways and Means bill saying a mediation process that has no qualifying threshold must be part of a reasonable Congressional solution to surprise bills.
SOAR - Save Our Air Medical Resources - also supports the Ways and Means bill because it requires the collection of data from air medical providers and insurers so that reimbursement rates would be based on actual cost and claims.
The other House bill, SOAR said, "would allow insurers to continue maintaining narrow networks and denying patients coverage after emergency transports, and empower insurance companies to set one reimbursement rate for all air medical providers by negotiating with only a single provider."
BOTH FALL SHORT
The Coalition Against Surprise Medical Billing said both proposals fall short as they rely on arbitration, which will end up costing consumers money.
"The proposal from the Ways & Means Committee relies solely on arbitration – essentially providing a handout to the very players who started this problem …" the Coalition said. "On top of that, the Education and Labor Committee's proposal significantly limits the benefits of fair, market-based rates by encouraging those specialists who charge the highest fees to recoup their costs through arbitration. Ultimately, these proposals would do very little to stop hospitals and private equity firms that continue to charge patients, employers and American taxpayers exorbitant prices for medical care."
Healthcare should be based on local, privately negotiated, market-based rates, the Coalition said.
THE LARGER TREND
Eighteen percent of all emergency visits and 16% of in-network hospital stays had at least one out-of-network charge, leaving patients at risk for surprise medical bills, according to the Kaiser Family Foundation.
The Ways and Means Committee introduced surprise billing legislation in December, to counter another bill that had been proposed.
In December, the House Committee on Energy and Commerce questioned eight major insurers and physician staffing firms about their role in surprise billing.
Despite bipartisan support, no surprise billing legislation was included in the year-end spending package, leaving the issues for lawmakers to try again in the new year.
ON THE RECORD
In releasing the Ways and Means proposal, Committee Chairman Richard E. Neal, D-MA and Ranking Member Kevin Brady, R-TX, said, "Our bipartisan approach differs from other proposals in that we require – for the first time – that patients receive a true and honest bill in advance of scheduled procedures and we create a more balanced negotiation process to encourage all parties to resolve their reimbursement differences before using the streamlined and fair dispute resolution process."
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