House reps unveil outline for surprise billing act: 5 things to know

A bipartisan group of U.S. House representatives released an outline of forthcoming legislation to end surprise medical bills. 

The outline, released May 23, comes from Reps. Raul Ruiz, MD, D-Calif.; Phil Roe, MD, R-Tenn.; Joseph Morelle, D-N.Y.; Van Taylor, R-Texas; Ami Bera, MD, D-Calif.; Larry Bucshon, MD, R-Ind.; Donna Shalala, D-Fla.; and Brad Wenstrup, R-Ohio.

Five things to know:

1. The Protecting People from Surprise Medical Bills Act addresses surprise billing, also known as balanced billing. This refers to situations in which privately insured patients receive large unexpected bills from the emergency department or out-of-network providers after medically necessary care at in-network hospitals. Patients receive these bills when insurers and providers disagree about the cost of care.

2. The legislation would prohibit balance billing patients for out-of-network care they did not expect, according to a news release.

3. Under the Protecting People from Surprise Medical Bills Act, an arbitration process would allow insurers and providers to settle disputes without involving the patient. The news release says the arbitration model is inspired by the "baseball-style" model adopted by New York state in 2015.

4. If out-of-network providers and insurers disagree about the cost of care, they would be allowed to use an independent dispute resolution process to resolve the payment issue. According to the news release, during the resolution process both sides would pick a cost for the patient’s care and a neutral arbiter would then decide which is more appropriate.

5. Representatives said the legislation would also require health plans to clearly identify in-network providers and patients' deductibles.

The finalized legislation is expected soon. Read more about the proposal here.


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5 legislative updates on surprise medical bills

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