Walorski Applauds Bipartisan Agreement to End Surprise Billing

Monday, December 14, 2020

Walorski Applauds Bipartisan Agreement to End Surprise Billing

Legislation Would Protect Patients from Surprise Medical Bills, Create Fair Dispute Resolution Process for Providers and Insurers

MISHAWAKA, Ind. – U.S. Rep. Jackie Walorski (R-Ind.) today released the following statement after House and Senate committee leaders reached a bipartisan agreement Friday on legislation to protect patients from surprise medical bills:

“Americans should be able to get the health care they need without facing financially devastating surprise medical bills. This bipartisan agreement will protect patients and their families, establish a process that keeps them out of billing disputes between providers and insurers, and ensure continued access to lifesaving emergency services such as air ambulances.

“I’m pleased our committees worked across the aisle to reach an agreement based on delivering commonsense solutions for the American people. Congress should quickly send this bill to the president’s desk so hardworking Americans who do everything right in both emergency and non-emergency situations never again find a costly, unexpected medical bill in their mailbox.”

BACKGROUND

Leaders of several House and Senate committees, including the House Ways and Means Committee on which Walorski serves, reached an agreement on legislation to protect patients from unexpected medical bills from out-of-network providers and establish a fair process to resolve payment disputes between insurers and health care providers.

The legislative package also includes a long-term extension of expiring public health programs, including Community Health Centers, National Health Service Corps, Teaching Health Centers, and Special Diabetes Programs.

The bipartisan, bicameral legislation would:

  • Hold patients harmless from surprise medical bills, including from air ambulance providers, by ensuring they are only responsible for their in-network cost-sharing amounts, including deductibles, in both emergency situations and certain non-emergency situations where patients do not have the ability to choose an in-network provider.
  • Prohibit certain out-of-network providers from balance billing patients unless the provider gives the patient notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services and the patient provides consent to receive out-of-network care.
  • Create a framework that takes patients out of the middle, and allows health care providers and insurers to resolve payment disputes without involving the patient.
    • Under the agreement, insurers will make a payment to the provider that is determined either through negotiation between the parties or an independent dispute resolution (IDR) process. There is no minimum payment threshold to enter IDR, and claims may be batched together to ease administrative burdens.
    • If the parties choose to utilize the IDR process, both parties would each submit an offer to the independent arbiter. When choosing between the two offers the arbiter is required to consider the median in-network rate, information related to the training and experience of the provider, the market share of the parties, previous contracting history between the parties, complexity of the services provided, and any other information submitted by the parties.
    • Following an IDR process, the party that initiated the dispute may not take the same party to arbitration for the same item or service for 90-days following a determination by the arbitrator. However, all claims that occur during the 90-day period are eligible for IDR after the 90-days.
  • Provide additional consumer protections when insurance companies change networks, including a transition of care for people with complex care needs and appeal rights for consumers
  • Empowers consumers by providing a true and honest cost estimate that describes which providers will deliver their treatment, the cost of services, and provider network status.

Text of the legislative is available here. Additional information is available here.

Walorski represents the 2nd Congressional District of Indiana, serving as a member of the House Ways and Means Committee.

###

Issues:

Get News & Updates