Surprise! – Effort to End Surprise Billing Still Alive

Surprise! – Effort to End Surprise Billing Still Alive

In last week’s update we told you about the pending retirement of Senator Lamar Alexander (R- Tenn.), who has been a champion of legislation to end surprise medical billing.  We feared the effort to end the practice would now be more difficult in Alexander’s absence.

Well, to our surprise, it was announced last Friday that House and Senate committee leaders have struck a deal on a bipartisan fix for the problem.

According to Bloomberg News, “The bipartisan agreement is between the top Democrats and Republicans on the House Energy and Commerce, Ways and Means, and Education and Labor committees, as well as the leaders of the Senate Health, Education, Labor and Pensions Committee.

“The measure would generally limit surprise billing in the following circumstances:

  • Out-of-network emergency services, which would include services furnished after a patient is stabilized unless notice and consent criteria are met.
  • Ancillary services, such as anesthesiology, radiology, and laboratory services, from an out-of-network provider.
  • Other services provided by an out-of-network provider at an in-network facility, unless notice and consent criteria are met.

Providers couldn’t send patients a balance bill for any amounts that exceed the cost-sharing requirement in those scenarios.

 Providers would have to give patients information on their network status, costs of out-of-network care, options for in-network providers, and other insurance requirements generally 72 hours before an appointment. The notice would have to clearly state that consent is optional, and that the patient could seek care from an in-network provider.

Patients would have to sign a consent form acknowledging they’ve been given written notice with the information and informed that the charges may not accrue toward any plan limitations.

 Health insurers would directly pay providers the difference between the out-of-network rate and the patient’s cost-sharing amount for those services. In states that don’t have their own systems, the out-of-network rate would be the amount that the provider and insurer agree to through an open negotiation process, or the amount set through an arbitration process.

 It’s likely the surprise billing package will be attached to the year-end government spending bill, as lawmakers attempted to do late last year, assuming they can come to an agreement by the end of the year.

House Speaker Nancy Pelosi (D-Calif.) said in a statement that the House would push for the deal to be included in a year-end legislative package.  However, Senate leaders haven’t signed off on the deal, according to a committee aide.

The agreement would make patients responsible only for their in-network cost-sharing amounts for both emergency services, including air ambulances, and some non-emergency care, according to the outline.

Ending surprise billing has been a priority for TSCL this year so we are very hopeful this bill does, in fact, finally pass.