Congress is considering various proposals to protect patients from surprise medical bills that occur after they unintentionally receive out-of-network care in emergency situations or at in-network hospitals. One point of contention between healthcare stakeholders has been whether should include a dispute resolution process, such as arbitration, for out-of-network payments between physicians and insurance companies.
Michael Lozano, MD, senior vice president at Envision Physician Services, told WUSF he is in favor of such a process, which is part of Florida’s law.
“You need a fair process where if they have a dispute, they have a way that they can come to an agreeable resolution of how to pay for a bill and not make the patient part of that,” he added.
Under Florida law, patients who receive out-of-network care at an in-network facility are only on the hook for the in-network fee. WUSF reported that the rest of the bill must be worked out by physicians and insurance companies, via a dispute resolution process.
A federal proposal passed by the House Energy and Commerce Committee in July includes a third-party arbitration process for resolving some out-of-network payment disputes. However, the Lower Health Care Costs Act, introduced by Senate health committee Chairman Lamar Alexander, R-Tenn., and health committee ranking member Sen. Patty Murray, D-Wash., would settle out-of-network billing disputes by requiring health plans to pay providers the local median contracted commercial amount that insurers have negotiated with other providers and agreed to in that local area.
Congress is on recess and reconvenes in September.
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