Surprise Billing Legislation is Gaining Traction with an Unknown Future for Physicians

By David Nicholson, Executive Vice President

Surprise medical bills occur when an insured patient unintentionally receives care from an out-of-network provider. And, according to a 2018 survey conducted by the University of Chicago, more than half of Americans (57%) have received at least one unexpected medical bill that they believed was covered by insurance.

The topic of surprise medical bills has become increasingly a topic of conversation in the healthcare industry, with a chorus of voices that are sometimes not in agreement, as policymakers come closer to enacting legislation to end surprise billing.

For your information, here is a recap of the recent movement surrounding this issue.

In May, a group of six senators introduced the Stopping the Outrageous Practice (STOP) of Surprise Bills Act of 2019 (S 1531). Additionally, leaders of the House Energy and Commerce Committee also released a discussion draft entitled the No Surprises Act.

Not  be outdone, in June, a number of Representatives introduced the Protecting People from Surprise Medical Bills Act (HR 3502) and most recently, following several amendments, the Lower Health Care Costs Act (S.1895), received approval from the Senate Health, Education, Labor and Pensions (HELP) Committee and is currently awaiting consideration by the full Senate.

The Lower Health Care Costs Act, if finalized, would eliminate surprise costs by prohibiting out-of-network deductibles and creating a benchmark for provider reimbursement based on local commercial rates. And while the CBO has projected the Lower Health Care Costs Act could reduce federal subsidies and potentially save $7.6 billion over the next decade,  some feel that these savings are coming out of the physician pocket.  Others concerns have been raised around the constitutionality of such legislation.

As reported by Becker’s Hospital Review and The Hill, a recent memo from the law firm Kirkland & Ellis, attorney Paul Clement explains how S.1895 could be in potential violation of the First and Fifth Amendments.

According to the memo, the proposed legislation may raise First Amendment problems because it could interfere with healthcare providers’ ability to associate together, refuse to associate with health insurance plans, and insist on higher reimbursement rates. Additionally, Clement states the proposed ban may also violate the Fifth Amendment’s Takings Clause, which is “designed to guard against forcing some people alone to bear burdens that should be borne by the public as a whole.”

Clement argues that the proposed legislation oversimplifies the issue and would give all negotiating power to the insurance companies. According to Clement, providers would have to choose between going in-network at payer-dictated rates or staying out-of-network at federal-dictated rates.

As the Lower Health Care Costs Act and other surprise billing legislation move forward, being informed is essential for physicians and taking an active role in this issue in their state and medical society’s efforts’ is of great importance.

The issue of surprise billing is far from settled with many voices crying out.  Don’t let your physician’s voice be silenced in the debate.

For more information on the legislative proposals to address surprise medical billing contact your local or national medical association.

 AdvantEdge Healthcare Solutions is a national top 10  medical billing company that offers  billing, coding and revenue cycle management solutions.   If you have questions about how this legislation affects your practice, please call us at 877-501-1611 or email