May 16, 2019 - Health

The Senate makes its move on surprise medical billing

Caitlin Owens

This image is a close-up of the very top of the US Capitol building. — Photo: Chris Kleponis/AFP/Getty Images

A bipartisan group of senators release the latest proposal to protect patients from surprise hospital bills on Thursday, only 2 days after the House Energy and Commerce Committee leaders released theirs.

The bottom line: Like most other proposals, the bill would protect patients from receiving out-of-network bills in emergencies, or when receiving scheduled care from out-of-network doctors at in-network facilities.

Yes, but: The leaders of the committee with jurisdiction over the issue are not sponsoring the bill.

Details: Providers would be paid the difference between a patient's in-network cost-sharing requirements and the median in-network rate for their services.

Insurers and providers could appeal that payment formula, and determine the rate using an arbitration process.
It also would require the Department of Health and Human Services to study the feasibility of hospitals and doctors submitting only one bill to patients for all of the services included in a single episode of care.

What we're watching: Whether providers view this blended approach as a reasonable compromise, or whether it just makes everyone mad that they didn't get exactly what they wanted.

Go deeper: Capitol Hill sees bipartisan momentum on surprise medical billing

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The Senate makes its move on surprise medical billing

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