American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

House Committees Advance Differing Legislative Solutions to Surprise Medical Billing

Last week, the House Committees on Education and Labor and Ways and Means considered different legislative approaches to address surprise medical billing. The House Committee on Education and Labor bill, H.R. 5800, the Ban Surprise Billing Act, sets a benchmark payment rate for unexpected out-of-network care at the median in-network rate. The legislation also includes an independent dispute resolution process for provider claims in excess of $750. Although the markup was contentious at times, the committee passed the legislation 32–13 with minor amendments. Committee members who expressed opposition to the legislation cited that rate setting would have damaging effects on the health care system and would unfairly provide more leverage to insurers in contract negotiations.

The House Committee on Ways and Means bill, H.R. 5826, the Consumer Protections Against Surprise Medical Bills Act, takes a different approach by not defining an initial payment, leaving payment disputes between an insurer and physician to an open negotiation and mediation process. This bill sets no threshold to reach mediation; however, the mediator may consider the median in-network rate as well as a wide range of supporting information submitted by either party in the dispute. The committee passed the legislation unanimously by voice vote. Read the ACS letter to Ways and Means.

For more information, contact Carrie Zlatos, American College of Surgeons Senior Congressional Lobbyist, at czlatos@facs.org.

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