“There will never be a broader bipartisan, bicameral solution to end surprising medical billing and we need to address it now,” Republican Senator Lamar Alexander said in a statement Sunday. “Patients cannot wait any longer.”
However, how Americans could be saved from unexpected bills ran aground in the months leading up to the coronavirus pandemic amid a lobbying and advertising flash by insurers on the one hand and hospitals and doctors on the other.
All efforts have protected the patients, who would pay the same amount they would if the providers were in the network. But who covers the rest of the tab is in dispute.
The last deal
The 372-page agreement was released jointly on Dec. 11 by chairpersons and rankings of the Senate Health, Education, Labor and Pensions Committees, the House Energy and Commerce, the House Ways and Means, and the House Education and Labor committees. It is expected to be added to the government spending bill this week.
Patients would only be responsible for sharing their costs across the network for both emergencies and certain non-emergencies where patients do not have the option to choose a provider in the network.
Non-network providers are prohibited from charging the balance to a patient unless they have communicated their network status and an estimate of costs 72 hours in advance and the patient agrees to receive care outside the network.
Insurers and providers would resolve the remaining bill through negotiation or an independent dispute resolution process. The arbitrator should consider the median network percentage, previous contracts, complexity of services, provider training, parties’ market share, and other factors. And there would be a 90-day window before the parties can return to arbitration for the same service.
Unlike previous deals, there would be no minimum payment threshold for participating in arbitration. And it relates to air ambulances, the services of which can be very expensive, but not ground ambulances.
Despite efforts by lawmakers to soften all sides, the deal still sparked criticism from insurers and providers.
The US health insurance plans continue to advocate a solution based on locally negotiated rates, not arbitration. It states that private equity firms, which have bought up specialist doctor’s offices that send many surprise bills, “are continuing to find ways to exploit the arbitration process to praise patients and increase healthcare for all.”
Meanwhile, the American Hospital Association also challenged several provisions, raising concerns about allowing arbitrators to consider Medicare and Medicaid payment rates during dispute resolution and holding hospitals accountable for, among other things, billing and payments of doctors.
And the American Medical Association sent a letter to Congressional leaders on Tuesday opposing the agreement, saying it would “significantly harm doctors’ practices already highlighted,” particularly smaller offices that may not have the resources to share. to participate in arbitration.