Senate surprise-billing proposal features payment benchmark

Senate health committee leaders have introduced a bipartisan legislative package that protects patients from surprise medical bills by banning out-of-network deductibles in emergencies, establishing a benchmark for health plan-provider payment disputes and ending unexpected air ambulance expenses.

The Lower Health Care Costs Act — formally introduced June 19 by Senate health committee Chairman Lamar Alexander, R-Tenn., and ranking member Patty Murray, D-Wash. — requires that patients only receive emergency healthcare charges that are counted toward their in-network deductible, according to the legislation.

Under the act, insurance companies would reimburse providers based on the local median contracted commercial amount they pay other providers they contracted with and agreed to in that geographic area. The legislation says HHS will be responsible for defining geographic areas and putting a consistent methodology in place for insurance companies to use to determine their median contracted rates.

Insurance companies that don't have adequate internal data in a given geographic area will be able to use the state's all-payer claims database or other appropriate external sources to determine the suitable market median rate, according to the act.

As far as ending surprise air ambulance bills, the legislation would limit patients' out-of-pocket costs for air ambulance transport to the in-network cost-sharing amount.

Mr. Alexander said in a news release that his committee will vote on the legislation June 26.

Access the full legislation text here.



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