“Surprise Billing” Legislation Shapes Up as a Fight at the Federal Level

As many of you might have seen on TV, the issue of “surprise billing” has come to the fore in healthcare, and AVLS is following this to ensure our members’ interests are protected.

On December 11, the House Ways and Means Committee issued an outline of that panel’s bipartisan proposal for addressing surprise medical bills.  Some details are vague, and it will be after the holidays and the impeachment matter before we see legislative language.  Nonetheless, direct conversations and written material signal that the committee’s approach offers improvements over the recently issued agreement reached between the House Energy & Commerce Committee and the Senate Health, Labor, Education, and Pension (HELP) Committee.

  • Like other proposals, the Ways & Means plan would limit patients’ out-of-pocket costs to the amounts they would have owed if they had the opportunity to choose in-network physicians and facilities to provide their care.
  • An independent dispute resolution (IDR) system is also included.  However, unlike other proposals, Ways & Means does not restrict IDR to claims above a certain threshold amount, nor does it establish a payment benchmark based on in-network payment amounts.
  • Price and network transparency provisions and protections for patients whose provider networks change during the plan year are also included.  Uninsured or cash-paying patients would also have access to IDR if they are given misleading cost information prior to obtaining services.

After the outline was released, Committee chair Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) both affirmed their commitment to advancing a balanced approach to address surprise billing early next year, noting that the issue is too complex and important to rush through Congress prior to the holiday recess.

The position of the AVLS  is to support for a solution to surprise medical billing that protects patients while avoiding harm to the practice of medicine or limits to access to care.    

During the recess, we encourage any member who has the oppotunmirty to discuss this issue with your member of Congress.