Hospital groups call for independent dispute resolution process as part of surprise-billing solution

Hospital groups are asking Congress to consider dispute resolution methods, such as mediation and arbitration, as part of a legislative solution to stop surprise medical bills.

In a May 28 letter to leaders of the House Energy and Commerce Committee, the groups call for these dispute resolution methods and outline their opposition to proposed rate setting policies.

The letter — from the American Hospital Association, America's Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States, Children's Hospital Association and Federation of American Hospitals — is in response to the recently released "No Surprises Act" draft.

The draft bill is designed to address unexpected charges patients see after they receive emergency care at an out-of-network hospital or receive nonemergency services from an out-of-network provider at an in-network facility.

Among other things, it would require insurers to pay out-of-network providers a minimum amount for the patient's care, based on the amount the insurer pays to nearby in-network providers, according to Vox. The publication notes the federal law would not supersede any state laws related to setting those payments.

In the letter, the hospital groups said they are concerned that the rate-setting provision of the legislation "is a plan-determined, non-transparent process that will upend private payment negotiation."

"A default rate will become the payment ceiling and remove incentives for insurers to develop comprehensive networks," they wrote. "Moreover, setting a payment rate is difficult to do properly in statute, even when a geographic adjustment is provided, given the many factors that are currently used to determine payment."

Instead, they urged the House committee to consider the establishment of a dispute resolution process, such as arbitration or mediation, to resolve payment issues.

They said this process "could serve as a backstop after a period of direct negotiation between payers and providers and could, as evidenced by the experience in New York state, both reduce the incidence of out-of-network billing and incentivize network participation. "

Read the full letter here.


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