Congressional panels agree on plan to ban surprise medical bills

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Democratic and Republican leaders of three House committees and one Senate committee have reached consensus on an approach to resolve surprise medical bills by banning physicians and hospitals from charging a patient fees their insurer will not cover and holding patients harmless when they receive emergency care from out-of-network providers. 

Democratic and Republican leaders of the House Energy and Commerce, House Education and Labor and Senate Health, Education, Labor and Pensions committees have been working  to pass a bill to reduce surprise medical billing for months. U.S. Rep Richard Neal, D-Mass., chairman of the House Ways and Means Committee, stalled their efforts, favoring his own proposal aimed at reducing surprise medical bills.

The committees' proposal, which is supported by unions, insurers and consumer groups, uses an approach called benchmarking, in which payment rates are based on the median amount insurers in a given area pay in-network healthcare providers. The proposal brought forth by Mr. Neal and Rep. Kevin Brady, R-Texas, favors a process in which outside adjudicators would decide payment rates through arbitration. This approach is supported by hospital groups.

The No Surprises Act employs an approach that is closer to Mr. Neal's bill, allowing providers to enter into arbitration to gain higher reimbursements. The arbitrator would consider factors such as median in-network rate, provider's experience level, complexity of the medical care and the parties' market share.

The last-minute agreement, reached Dec. 11, increases the chances of the legislation being part of the year-end government funding package Congress is trying to finalize.

"Under this agreement, the days of patients receiving devastating surprise, out-of-network medical bills will be over," Senate committee leaders wrote in a joint statement. "Patients should not be penalized with these outrageous bills simply because they were rushed to an out-of-network hospital or unknowingly treated by an out-of-network provider at an in-network facility."

However, the American Hospital Association expressed concern with several provisions of the legislation. Two specific modifications the AHA wants to see  are penalties for health plans that fail to reimburse providers for out-of-network care and clarification that out-of-network providers are responsible for managing their own notice and consent process with patients. 

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