Federal surprise-billing legislation will likely pass Congress by end of year, US senator says

Sen. Bill Cassidy, MD, R-La., said he thinks federal surprise-billing legislation will pass Congress by the end of 2019.

His projection came during a speech at the Medical Group Management Association's annual meeting in New Orleans.

"When we go back over the next month or so, there'll be some decision as to where we end up between … two [proposed solutions]. And I suspect some legislation will pass, and it'll pass by the end of the year," the senator told conference audience members.

Congress — which is set to reconvene in Washington, D.C., this week — has been debating proposed solutions to surprise medical bills, those occurring when a patient is billed out of network despite going to an in-network facility.

Debate on the issue concerns how to resolve out-of-network payment disputes between insurance companies and physicians. Two ideas under consideration are reimbursing providers based on benchmark rates and an arbitration approach.

Under legislation introduced by Mr. Cassidy, Sen. Maggie Hassan, D-N.H., and a bipartisan group of senators, a patient who visits an in-network facility or any healthcare facility in an emergency situation and receives out-of-network care would only be required to pay what in-network charges would have been.

Mr. Cassidy said if the physician or hospital is paid by the health plan at a rate less than they believe is fair, both sides have time to negotiate. If a resolution can't be reached, the parties would go to arbitration. The arbiter would look at proposals from both sides and determine the amount that is most fair. This style of arbitration is already used in New York state.

Congress is also considering a benchmarking approach used in California. Implemented in 2017, it requires insurers to pay out-of-network health professionals a benchmark, locally negotiated market rate.


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