Washington, D.C. – Today, U.S. Senators Michael Bennet (D-CO) and Bill Cassidy, M.D. (R-LA), along with Senators Todd Young (R-IN), Maggie Hassan (D-NH), Lisa Murkowski (R-AK), and Tom Carper (D-DE), members of the bipartisan Senate health care price transparency group, introduced the bipartisan STOP Surprise Medical Bills Act, legislation to protect patients from surprise medical bills. This legislation is a product of a nearly year-long effort revising proposals and requesting feedback on draft legislation released last September by the working group.
“The last thing a patient should have to worry about is being blindsided by unanticipated, and potentially financially devastating, medical bills. People deserve to know how much they are paying for health care services and procedures at the point of care,” Bennet said. “Our bill would help protect patients from surprise medical bills, increase transparency, and alleviate the financial burdens imposed on consumers as a result of these bills. I urge my colleagues to prioritize this bipartisan legislation to give much needed relief and predictability to Americans throughout the country.”
Recent examples of patients receiving surprise medical bills include a patient who received a bill nearly $109,000 for care after a heart attack, and a patient who received a bill for $17,850 for a urine test.
In February of this year, Bennet and Cassidy led the working group in requesting more detailed information from the health care industry to supplement the input they received regarding the draft surprise medical bills legislation released in September 2018.
A section-by-section is available HERE.
The STOP Surprise Medical Bills Act addresses three scenarios in which surprise medical billing (also known as “balance billing”) would be prohibited:
- Emergency services: The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.
- Non-Emergency services following an emergency service at an out-of-network facility: The bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
- Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.
Providers would automatically be paid the difference between the patient’s in-network cost-sharing amount and the median in-network rate for these services, but providers and plans would have the opportunity to appeal this payment amount through an independent dispute resolution process, should they see fit. This “baseball-style” process would entail the plan and provider submitting offers to an independent dispute resolution entity that has been certified by the Secretaries of Health and Human Services (HHS) and the Department of Labor. This entity would make a final decision based upon commercially-reasonable rates for that geographic area.
The patient is completely removed from this process between the provider and the plan, and regardless of any outcome from a dispute resolution process, the patient still only owes the in-network rate. States that have established an alternate mechanism for protecting patients and determining payment amounts for providers would be able to continue with those systems.