Surprise Medical Bills Legislation Proposed

A House committee is reportedly fighting to pass surprise medical bills legislation which would help protect patients from unexpected hospital expenses.

Surprise medical bills may occur when a patient receives charges from out of network providers. For most health plans, there are preferred “in network” providers who are compensated at a higher rate than “out of network” providers. If a patient thinks they are seeing an in network provide but are faced with out of network costs, they may be surprised by the massive medical bills they accrue.

Although out of network costs is one part of surprise medical bills, these unexpected expenses may also stem from a practice called “balance billing.”

Balance billing occurs when a health insurance plan determined “allowed” payments with a provider but does not cover the full cost of treatment. With in network providers, any difference between the total charge and the “allowed” charge cannot be passed onto patients. However, out of network providers are able to pass these costs onto patients in addition to any deductible or out of pocket costs they may need to pay.

Federal legislators are trying to reach a compromise between patients, healthcare providers, and insurance companies which can protect consumers from these large surprise bills.

Proposed Surprise Medical Bills Legislation

Recently, leaders from the House’s Ways and Means Committee proposed a plan to resolve pending surprise medical bills legislation. However, this plan contradicts a previous bipartisan deal between the House and Senate committees.

The plan, originating from Chairman Richard Neal and committee member Kevin Brady, reportedly calls for “an independent mediated negotiation process” if private negotiations between providers and insurers break down.

This approach reportedly moves closer to the outcome advocated for by doctors and hospitals. According to these providers, the House-Senate deal reached in December would give too much power to health insurance companies.

The bipartisan deal would take a different approach to disputes. Instead of going through mediation, the plan would settle disputed payments to providers at a pre-determined federal payment. These payments would reportedly be based on median in-network costs. Under the plan, outside mediation would be available for certain cases – for example, if a billing dispute is over $750.

Although the bipartisan plan and the House plan differ, Chairman Neal has reportedly downplayed the differences between the two outcomes.

“Frank and I are going to try to get together pretty fast with [House Majority Leader] Steny [Hoyer], and we don’t think there are big differences between the Ways and Means bill and the E&C bill,” Neal said in defense of the plan, according to Politico.

Senate Minority Leader Chuck Schumer is reportedly a key player in the race to pass surprise medical bills legislation. Although he hasn’t made a statement that he would stop the Senate-House bill, Schumer reportedly prefers legislation that mimics New York’s approach.

The New York approach utilizes “baseball-style arbitration” to resolve disputes and has reportedly saved over $400 million over the course of three years.

“Given that New York State already has a strong, patient-friendly law on the books that seems to be working, Sen. Schumer wanted to make sure that any federal anti-surprise billing legislation did not have an adverse impact on patients in New York,” a Schumer spokesperson said, according to Politico.

Although Schumer supports this approach, critics of the law say that it has resulted in hospitals charging more for medical care which patients have to compensate for in the form of higher premium payments.

Join a Free Surprise Medical Bill Class Action Lawsuit Investigation

If you were hit with a surprise medical bill from an out-of-network doctor at an in-network hospital, you may be entitled to compensation.

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This article is not legal advice. It is presented 
for informational purposes only.