U.S. House of Representative’s Ways & Means Committee Chairman Richard Neal (D-Mass.) and Ranking Minority Member Kevin Brady (R-Tex.) have proposed legislation to resolve the “surprise billing” issue that could finally put the issue to rest.
Neal and Brady first released a rough outline of their proposal in December 2019, but last week full details of the plan emerged. Most importantly, the plan calls for patients to be protected from surprise medical bills for out-of-network services. The bill would also afford patients greater transparency about these potential situations by requiring insurers to provide accurate and up-to-date information regarding provider networks and an Advance Explanation of Benefits for services scheduled schedule at least three days in advance.
In resolving payment disputes for such out-of-network occurrences, the bill fosters open-negotiation between providers and insurers. If the requested or proposed payment amount is unsatisfactory, either side can initiate a “baseball style” mediation process administered by independent third parties without any affiliation to providers or payers. Under this model of arbitration, both sides will come to the table with their best offers and an arbitrator will choose one over the other following guidelines that will be determined through a rulemaking process.
MHA President & CEO Steve Walsh said “The hospital community is grateful for Chairman Neal’s extraordinary leadership on the issue of surprise billing. The bipartisan Ways & Means proposal provides important protections and transparency for patients while bringing insurers and care providers together to negotiate without undue government interference in private contracts. It correctly takes patients out of the middle of surprise billing disputes and holds insurers accountable for their responsibilities in these situations. This approach is the first fair and balanced solution we have seen emanate from Congress.”