The U.S. House Ways & Means Committee, chaired by Massachusetts Democrat Richard Neal, announced that it has reached bipartisan agreement to resolve the “surprise billing” issue.
The Ways & Means proposed solution stands in contrast to other proposals that have been floated recently in Congress, including a recent joint proposal from the Senate HELP and House Energy & Commerce committees that hospitals believe would ultimately harm patient access to care.
Surprise billing occurs when an insured patient receives services from an out-of-network provider in an emergency situation (say, ED care after a car accident) or is treated by an out-of-network clinician at a facility that is in network (for example, the anesthesiologist is the only member of a surgical team not in the patient’s insurance plan). Just about every stakeholder, including hospitals, believes that patients should be protected from surprise bills and should pay no more than they would have paid if a service had been covered under their insurance plan. Determining how the out-of-network provider should be reimbursed has been the subject of debate.
The Ways & Means plan – the full details of which are not yet public – protects patients from surprise billing scenarios and calls for arbitration when providers and insurers disagree on the reimbursement for out-of-network services. This approach respects private market dynamics between insurance companies and healthcare providers by allowing them to work out differences without interference. If the parties cannot come to agreement, the Ways & Means proposal provides for a structured and impartial process to reach resolution.
The alternative being pushed by insurance companies is for the government to set a “benchmark” rate, meaning that every provider in a specific market gets some sort of government mandated rate for the care provided. Because certain providers in a similar geographic area may have substantially different costs, an artificially low, across-the-board reimbursement rate could hurt those providers that are already at risk.
MHA President & CEO Steve Walsh said of the Ways & Means proposal, “The hospital community is grateful for Chairman Neal’s extraordinary leadership on this issue. The Ways & Means proposal provides important protections and transparency for patients without undue government interference in private contracts. It is directly responsive to the priorities of the hospital and physician communities.”
Walsh and Mass. Medical Society President Dr. Maryanne Bombaugh met recently with Neal on Capitol Hill. Last week, this
Cutting through the clutter on surprise billing op-ed from Walsh and Mass. Medical Society President Dr. Maryanne Bombaugh ran part of
The Boston Globe’s opinion series on choosing, using, and losing healthcare.