House and Senate Announce Surprise Billing Agreement

On December 11, 2020, the House and Senate committee announced a bipartisan agreement on surprise medical billing that will establish a fair framework to resolve payment disputes between health care providers and health insurance companies.

The bipartisan will include the following:

  • Creates a framework that focuses on health care providers and insurers to resolve payment disputes without the patient involved.
  • Patients can’t be harmed from surprise medical bills, ensuring they are only responsible for in-house network cost-sharing amounts, including deductibles.
  • Added protection when insurance companies change networks.
  • Consumers will have an accurate and honest cost estimate that informs which provider will deliver their treatment, the cost of services, and provider network status.
  • Certain out-of-network providers can’t balance bill patients unless the provider gives the patient notice of their network status and an estimate of charges 72 hours before receiving out-of-network services. The patient provides consent to receive out-of-network care.
  • Insures will make a payment to the provider determined either through negotiation between the partied or independent dispute resolution (IDR) processes.
  • If partied utilize the IDR process, both parties would submit an offer to the arbiter. The arbiter will look to consider the median in-network rate, market share of the parties, previous contracting history, the complexity of the services, and any other information submitted. 
  • The part that initiated the dispute may not take the same party to arbitration for the same item or service for 90-days following a determination. 

The agreement 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.

Source: U.S. House of Representatives