Surprise Billing Legislation Moves Forward in DC

Washington DC capitol building

United States Capitol A small group of federal lawmakers announced they have reached an agreement on legislation to address surprise medical billing, which would prohibit balance billing in certain scenarios and set government-mandated rates for out-of-network services.

Under the legislation, patients would be required to pay only the in-network cost-sharing amount when they receive out-of-network emergency care, ancillary services from out-of-network providers at in-network facilities and in other scenarios. The balance of the medical costs would be the responsibility of the patients’ insurance company, but insurers would only be required to reimburse providers, at minimum, the median in-network negotiated rate for the service in the geographic area where the service was delivered.

Surprise medical billing occurs when a patient receives care from providers or at facilities that are not part of that individual’s health benefit network. Earlier this year, committees in the U.S. House and Senate moved on legislation that aimed to address these bills, which are sometimes called surprise medical bills or balance bills.

The MHA and the American Hospital Association support legislation that protects patients from surprise medical bills, but are opposed to the government-mandated rate setting included in this legislation.

The MHA believes providers and insurers can resolve the balance of out-of-network payments between insurers and providers without further government interference and without requiring patients to pay anything additional. Government price setting will disadvantage hospitals and providers in contract negotiations and could lead to severe financial repercussions for Michigan hospitals.

A subsequent bipartisan agreement announced by the House Committee on Ways and Means Dec. 11 could slow the movement on this legislation. An analysis of the new proposal is not yet available, and the MHA will provide updates as these proposals progress.  

Michigan hospitals are encouraged to contact their members of the U.S. House of Representatives and Sens. Debbie Stabenow and Gary Peters to ask for their support in eliminating surprise medical bills to patients without requiring government rate-setting that gives insurers an unfair market advantage over hospitals and physicians. For more information about surprise billing, contact Laura Appel at the MHA.