The House Ways and Means Committee released a much-awaited proposal to stop "surprise" medical billing on Feb. 7.
Surprise medical billing, or balance billing, occurs when a patient visits an in-network facility but receives out-of-network charges, often because physician groups may not be in the same networks as the hospitals they work at. The issue is significant — it affects patients in 18 percent of emergency room visits and 16 percent of hospital stays, according to Kaiser Family Foundation data cited by the committee.
The proposal would bar providers from balance billing patients when they visit in-network facilities. 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. It also lays out a framework for payer-provider mediation.
"We recognize that any solution to this problem touches every part of our nation's healthcare system. We want to minimize the burden on patients and keep the dispute resolution process neutral," said Committee Chairman Rep. Richard Neal, D-Mass., and ranking member Rep. Kevin Brady, R-Texas, in a press release.
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