New Draft Legislation Targets Out-of-Network Billing

Category: Senate, health legislation, healthcare law

New Draft Legislation Targets Out-of-Network Billing


On May 23, the U.S. Senate Committee of Health, Education, Labor & Pensions released the Lower Health Care Costs Act of 2019 discussion draft that would ban “Surprise Medical Bills.” Under the bi-partisan legislation, patients would only be required to pay the in-network amount, whether they receive out-of-network emergency care or non-emergency care at in-network facilities and are treated by out-of-network providers.

The Committee’s proposal offers three (3) options for public debate before determining the final methodology for inclusion in the Act:

1) Choosing an in-network hospital means receiving in-network care: For patients, if a hospital takes your insurance card, then every practitioner at that hospital also has to take your insurance card. For providers, they can choose to join the insurance networks that cover that hospital or they can choose to send the bill through the hospital rather than sending separate bills to the patient or insurer.

2) Benchmark: For surprise bills, insurance companies would pay providers the median contracted rate for the same services provided in that geographic area.

3) Arbitration: For surprise bills over $750, the insurer or the provider can initiate an independent dispute resolution process. The insurer and provider would each submit a best final offer and the arbiter will make a final, binding decision on the price to be paid. For surprise bills less than $750, the insurer will pay the provider the median contracted rate for the same services provided in that geographic area.

The Senate Health Committee is requesting comments on the discussion draft. To be considered, comments must be submitted by 5 PM on Wednesday, June 5, 2019 at LowerHealthCareCosts@help.senate.gov.

To read the full bill draft, go here

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