Senators release plan to end surprise medical bills with arbitration: 8 things to know

A bipartisan group of senators has unveiled legislation to end surprise medical bills. 

Eight things to know:

1. Sens. Maggie Hassan, D-N.H., Bill Cassidy, R-La., and a bipartisan group of senators introduced the STOP Surprise Medical Bills Act May 16. Ms. Hassan and Mr. Cassidy, along with Sens. Michael Bennet, D-Colo., Todd Young, R-Ind., Lisa Murkowski, R-Alaska, and Tom Carper, D-Del., announced the introduction of the bill.

2. The legislation would prohibit surprise billing for emergency services. Under the act, a patient would only be financially responsible for the in-network cost-sharing amount required by their insurance company for these services, according to a press release from Ms. Hassan's office. This would apply at an out-of-network facility or if the patient is seen by an out-of-network provider as well.

3. The legislation would also prohibit surprise billing for non-emergency services that a patient needs following their emergency care at an out-of-network facility, according to the press release. This refers to situations in which patients require additional non-emergency services after receiving emergency care at an out-of-network facility, but the patient would require medical transport to go to another facility.

4. Additionally, the legislation aims to protect patients from receiving surprise medical bills after receiving non-emergency services by an out-of-network provider at a facility that is in their insurance company's network, Ms. Hassan's office said.

5. The legislation includes an arbitration process. According to the senators, providers would be reimbursed based on the difference between the patient's in-network cost-sharing amount and the average in-network rate for these services.

6. The payment amount would be subject to appeal via an independent dispute resolution process inspired by Major League Baseball's arbitration process. Under this process, the health plan and provider would submit their own offers to an independent dispute resolution entity. The entity would be one that has been certified by HHS and the U.S. Department of Labor, and it would decide on the final payment amount "based upon commercially-reasonable rates for that geographic area," Ms. Hassan's office said.

7. The Senate's proposed surprise billing legislation comes days after Republican and Democratic representatives on the House Energy and Commerce Committee released their own draft legislation to protect patients from surprise medical bills.

8. Sen. Lamar Alexander, R-Tenn., chairman of the Senate's health committee, has also been working with Sen. Patty Murray, D-Wash., to address the issue and hopes to release a proposal in June, according to The Hill.

 

More articles on healthcare finance:

OhioHealth's Margaret Schuler on automation in revenue cycle and meeting patients' expectations
Federal push for greater price transparency would likely affect insurers less, Fitch analyst says
RCM tip of the day: Collaborate with payers

 

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