Senators Propose Bipartisan Measure to Shift Excess Costs of Surprise Medical Bills to Health Plans

September 21, 2018

A bipartisan group of senators introduced a draft proposal to require group health plans to pick up the excess costs from surprise medical bills given by doctors who are unknowingly out-of-network.

The Protecting Patients from Surprise Medical Bills Act addresses three scenarios of surprise billing:

  • Emergency services provided by an out-of-network provider in an out-of-network facility:  Patients would only be required to pay the cost-sharing amount required by their health plan, and anything above this amount must be paid by the health plan.

  • Non-emergency services performed by an out-of-network provider at an in-network facility:  Patients would only be required to pay the cost-sharing amount required by their health plan, and anything above this amount must be paid by the health plan.

  • Non-emergency services following an emergency service from an out-of-network facility:  The health care provider must notify the patient that they may have to pay higher cost-sharing than if they had received in-network treatment, and they must give the patient the option to transfer to an in-network facility.

Sponsors of the legislation include Sens. Bill Cassidy (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO), all members of the Senate health care price transparency working group.

Final bill to be introduced next year:  Sen. Cassidy said that lawmakers will refine their legislation before formally introducing the bill in the next Congress in January 2019.