New federal surprise billing laws proposed: 7 things to know

Morgan Haefner and Emily Rappleye - Print  | 

Lawmakers proposed two bipartisan bills to help patients avoid surprise medical bills Feb. 7.

Seven things to know:

1. One proposal would bar providers from balance billing patients when they visit in-network facilities. Ways and Means Committee Chairman Rep. Richard Neal, D-Mass., and ranking member Rep. Kevin Brady, R-Texas, drafted the proposal. The legislation is called the Consumer Protections Against Surprise Medical Bills Act of 2020.

2. It requires payers to give patients a cost estimate with information on who will treat them and the provider's in-network status ahead of any scheduled procedure, according to a summary of the bill. 

3. The proposal differs from other bills in that it includes an independent, outside arbiter to set rates for out-of-network services. The arbiter still has to take into account region-specific mean rates when making the decision. 

4. The second proposal builds on previous bipartisan agreements. Committee on Education and Labor Chairman Rep. Bobby Scott, D-Va., and Ranking Member Rep. Virginia Foxx, R-N.C.,  drafted the legislation, called the Ban Surprise Billing Act.

5. Under this legislation, patient cost-sharing would be limited to in-network rates. Payment disputes between payers and providers would be decided based on the amount of the bill. The proposal relies on a market-based benchmark of the median in-network rate for amounts $750 or lower, or $25,000 for air ambulance services. For bills higher than those thresholds, providers and payers can use an independent dispute resolution to address payment disputes.

6. Surprise bills affect patients in 18 percent of emergency room visits and 16 percent of hospital stays, according to Kaiser Family Foundation data cited by the Ways and Means committee.

7.  While many see surprise billing legislation as a rare area of bipartisan support among Republicans and Democrats, differences in approaches and lobbying efforts have slowed any deal-making, and will likely do the same with these legislations.

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