How surprise billing is caused: When facility-based physicians decline to participate in networks, the amount they can bill for services is unlimited.
The letter calls for Congress to:
- Eliminate balance billing by emergency providers, out-of-network providers at in-network facilities, and providers who consistently produce surprise bills under the current system;
- Incentivize providers to join networks and reject mandatory arbitration that is being advocated by other groups to settle bills;
- Increase transparency by requiring facility-based physicians to disclose cost and quality data so patients can make informed choices about treatment; and
- Support ERISA and protect self-insured plans from a maze of state laws relating to surprise billing.
Medical groups and hospital associations have also sent letters to Congress with their own sets of principles, some of which could increase employer costs.
Outlook: With mounting public pressure to do something on surprise medical bills and President Trump supporting some action, the potential for Congress to pass legislation is fairly high. But it is unclear how Congress will address the competing interests of payors and out-of-network providers.
