More on Policy and Legislation

Surprise billing legislation unanimously passes Ways and Means

Insurers should be required to maintain robust networks, or the trend towards out-of-network services will accelerate, says physician advocates.

Susan Morse, Managing Editor

The House Committee on Ways and Means on Wednesday unanimously passed the Consumer Protections Against Surprise Medical Bills Act.

Under the law, patients would receive a cost estimate of treatment services upfront, along with the provider's network status.

The bipartisan proposal now goes through the House.

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Providers support proposals to end surprise billing, but differ on how that should be done.

Hospitals are against a law that sets a benchmark rate for disputed amounts, and many are in favor of the Ways and Means bill because it instead relies on insurers and providers working together through an arbitration process.

The Association of American Surgeons and Physicians argued against the Ways and Means legislation, saying its requirement to not allow patients to be charged more than the in-network cost-sharing amount would lead to even narrower networks.

The Physicians Advocacy Institute also said the legislation must address the limited provider networks that have created the surprise bill epidemic.

The Institute also wants any mediation process to take into account physician data provided by an independent data collection entity, to ensure fairness.

"Using insurers' payment data to resolve disputes would undermine patients' access to important medical care, because, as the Congressional Budget Office recognized, unrestrained marketplace clout will drive rates down artificially, sometimes below the cost of medical services," Physicians Advocacy Institute President Robert W. Seligson said.


The Ways and Means bill and a second bill from the House Committee on Education and Labor are similar to legislation proposed in December. Bills are now going through the legislative process during the 2020 election year.


"Insurers should be required to maintain robust networks, or the trend toward out-of-network services that force patients to pay more will continue to accelerate," Seligson said.

Ways and Means Chairman Richard E. Neal, D-MA, said, "The Ways and Means legislation adds much-needed transparency and protections for patients, ensuring they know the cost of treatments up front and that they aren't saddled with the responsibility of resolving billing disputes."

Dr. Patrice A. Harris, president of the American Medical Association said, "We support the underlying mechanism for resolving these disputes, including the eligibility of all disputed claims for negotiation and mediation. We also appreciate that the mediator must consider a wide range of supporting information submitted by physicians in rendering a final determination." 

Twitter: @SusanJMorse
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