Senate Committee Tackles Surprise Billing

The Senate Health Committee finally passed a major health care package, which could bring an end to surprise billing for patients by capping out-of-network charges at a rate already negotiated by insurers. However, the legislation could see more changes before it sees a full Senate vote.

Wednesday, the Senate Health, Education, Labor and Pensions (HELP) Committee debated S. 1895, the Lower Health Care Costs Act, which included provisions related to protecting patients from surprise medical bills. Included in the bill is language that addresses a variety of other issues, including prescription drug pricing, provider network and pricing transparency, mental health and substance abuse parity, and tobacco regulation. The bill was voted out of committee 20-3.

The surprise billing provisions of the bill are problematic because they would tie out-of-network payments to average in-network rates in situations where a patient did not have the opportunity to choose an in-network provision. It also omits the independent payment arbitration process that the Medical Association of the State of Alabama and the AMA and other physician organizations support.

Physician Sen. Cassidy, (R-LA) offered an amendment to require insurers to post information on network adequacy so that patients can find out in advance if their doctor is in network, which was passed unanimously. Committee Chair Alexander also made a commitment to continue working with members of the Cassidy Working group to address physicians’ concerns about the lack of an arbitration model to address payment disputes. Sen. Cassidy also made strong comments against the surprise billing section in the underlying bill, noting that is it skewed heavily in favor of insurance companies. He warned that letting insurance companies set rates will have dire consequence for rural and critical access hospitals that are already closing due to inadequate payments and it will exacerbate health care market consolidation problems. Sens. Hassan, Romney and Murkowski were also outspoken, expressing concerns with the contracted in-network rate benchmark and speaking in favor of including of an independent dispute resolution mechanism.

The HELP committee is hopeful the bill will be considered on the Senate floor by the end of July. We will continue working with the principals involved to try and get our concerns with the legislation addressed through the amendment process.

Separately, Congressman Ruiz, MD (D-CA) and a significant number of co-sponsors from both sides of the aisle introduced surprise billing legislation Thursday in the House that is based on the New York model.  This is the bill that most physician groups including the Medical Association and the AMA have been waiting to support. This bill includes an independent dispute resolution process with benchmark rates tied to charges.

The Medical Association will continue to monitor developments on the surprise billing legislation and will keep the membership apprised.