House Energy and Commerce health subcommittee hearing on surprise billing: 8 takeaways

The House Energy and Commerce health subcommittee held a surprise-billing hearing June 12 as lawmakers work to find a legislative remedy for the issue.

Eight takeaways:

1. Energy and Commerce Chairman Rep. Frank Pallone, D-N.J., delivered opening remarks at the hearing on, "No More Surprises: Protecting Patients from Surprise Medical Bills."

2. Mr. Pallone, who released draft surprise-billing legislation May 14 with Greg Walden, R-Ore., said, "It is long past time for Congress to take decisive action to protect patients from the unreasonable and unacceptable practice of surprise billing.  Every day, we hear new stories about American families being devastated financially and put through the tremendous emotional toll of surprise medical bills."

3. Mr. Pallone also outlined the subcommittee's plan during his opening remarks.

4. The proposal prohibits balance billing of patients for out-of-network emergency services or for scheduled services provided by an out-of-network provider that patients didn't realize would be involved in their care.

5. Under the House draft legislation, health plans also would be required to pay at least the median in-network rate for the service in that geographic area.

6. While testifying about surprise-billing legislation, Vidor E. Friedman, MD, president of the American College of Emergency Physicians, recommended that Congress consider placing caps on patient responsibility for unanticipated emergency medical care, as well as an independent dispute resolution process once the patient is "out of the middle" of billing disputes between providers and insurance companies. 

7. James Gelfand testified on behalf of the ERISA Industry Committee, which represents large health plan sponsors. He spoke against implementing binding arbitration and told the panel the draft legislation "creates a reasonable, market-based benchmark in surprise-billing situations, taking the patient out of the middle, and providing certainty to plans, plan sponsors, patients and providers."

8. Federation of American Hospitals President and CEO Chip Kahn issued the following statement on the hearing:

"The best resolution to surprise billing is federal policy that protects patients, only holding them responsible for their in-network cost-sharing amount for unavoidable out-of-network events. With the patient protected, caregivers and insurers can negotiate an appropriate payment — with the law putting in place an arbitration process if necessary."


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