Congress Looking to Curb Surprise Medical Bills

The House Energy and Commerce Committee is debating a bill meant to limit surprise medical bills for out-of-network patients. At issue are patients who make a “good faith” attempt to see a provider in network, but still get hit with out-of-network bills. For example, patients who visit an in-network hospital, but are seen by a physician or anesthesiologist who is out-of-network.

The debate currently is focusing on two ways to limit such bills. Insurance companies are supporting a benchmark plan where payment will be determined by average, regional contract rates. In essence, this would apply a PPO discount to out-of-network charges. Providers would be required to accept the benchmark rates and discount accordingly. 

Conversely, physician groups are promoting an arbitration method to settle surprise out-of-network billing, on order to prevent government mandated rates. A recent amendment to the proposed bill has added the possibility of a compromise, where arbitration is only possible on bills over $1,250.

The Blue Cross and Blue Shield Association recently released a statement regarding the debate in which they announced their support for the benchmark plan, hoping to “maintain the benchmark protections and reject the establishment of a cumbersome arbitration process that will raise costs for everyone.” In defense, they cited the Congressional Budget Office’s estimate that the plan would save $25 billion in costs.

Regardless of the proposed bill’s future, it stands as a reminder of the healthcare industry’s constant pursuit of savings in the fact of cost inflation, as well as the industry’s push away from out-of-network services.

David Swiercz