HR Policy Urges Congress to Pass Legislation to Prevent Surprise Billing

April 05, 2019

In a letter submitted for a congressional hearing on surprise medical billing, HR Policy urged lawmakers to consider recommendations to protect patients from surprise medical bills without raising health care costs for any payer, or undermining access to high-quality, value-based health care networks.

HR Policy wrote to the House Subcommittee on Health, Employment, Labor, and Pensions: “A significant driver of high health care costs are the substantial bills that millions of patients with comprehensive insurance coverage receive every year from out-of-network providers they did not seek out for care and, often, never even knew treated them.  In most cases, these surprise bills occur when a patient receives treatment at an in-network facility but one or more out-of-network facility-based providers perform services for them.”

Potential solutions discussed at the hearing included requiring hospitals to ensure that providers practicing at their facility bill in-network prices, while also capping rates to a percentage of Medicare reimbursements in emergency situations.

HR Policy’s recommendations to alleviate the burden of surprise billing included:

  • Ensuring patient cost-sharing is limited to in-network amounts for emergency services performed at an out-of-network facility or for treatment by out-of-network facility-based providers performed at in-network facilities;

  • Establishing a federal benchmark rate to be paid by plans and plan sponsors to these out-of-network providers based upon 125% of the Medicare rate, or the average/median rate the plan would pay to in-network providers in the geographic market;

  • Preserving the ability of self-insured employers to provide uniform health benefits to employees and retirees across the country; and

  • Protecting value-based payment arrangements.

Opportunity for a bipartisan solution:  Rep. Van Taylor (R-TX) said during the hearing, “This is a real problem that's affecting people every single day.  I'd rather have something that's going to go all the way to the president's desk than something that's not going to get anything done."  Taylor and Subcommittee Chair Frederica Wilson (D-FL) agreed to work together to draft a bipartisan solution to be considered by the Senate and President Trump.