Baseball-style arbitration on the table as potential surprise billing solution

Baseball-style arbitration is among the solutions U.S. lawmakers are proposing to prevent surprise medical bills, according to a Bloomberg report.

Five things to know:

1. Surprise medical bills occur when insurers and physicians disagree on what the care is worth, and the patient ends up on the hook for the remaining balance after the insurance company pays a portion of the bill. They often happen in emergencies when patients see providers who are not in their insurance company networks.

2. The issue has come to the forefront after President Donald Trump vowed to end surprise medical bills that leave patients with high, unexpected out-of-pocket costs. U.S. senators of both parties, who are trying to reach a consensus on addressing surprise medical bills, are also seeking information from the healthcare industry on the matter.

3. Baseball-style arbitration is one solution already being used in some states, including New York, according to Bloomberg. In this scenario, the physician and insurer reportedly each submit a price, an arbiter picks one, and the decision is binding on both sides. Patients who received out-of-network care reportedly are charged no more than the amount they would owe to in-network providers.

4. Democrat Sen. Maggie Hassan of New Hampshire has proposed something similar. According to Bloomberg, her plan would use baseball-style arbitration but also require arbitration decisions to be made public.

The senator told the publication: "You have health plans, insurance plans and providers negotiating about the fate of a patient who has very little control over this level of coverage and pricing. We also have a system with very little transparency in pricing, and so it isn't operating as a typical market system might."

5. A bipartisan group of senators, including Republican Sen. Bill Cassidy, MD, of Louisiana, also has proposed legislation. Bloomberg reported the group's proposal would set reimbursements for out-of-network care based on typical payments in given markets.


More articles on healthcare finance: 

Mississippi lawmakers dodge action on surprise billing remedy
Task force offers tool to assess potential value-based care partners
Senators ask insurers, providers for data on surprise billing


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