May 20, 2019

Momentum Gains for STOP Surprise Medical Bills Act as Senators Join Bill

WASHINGTON—U.S. Senator Bill Cassidy, M.D. (R-LA) today announced the addition of U.S. Senators Kevin Cramer (R-ND), Ben Cardin (D-MD), John Kennedy (R-LA), Bob Casey (D-PA), Joni Ernst (R-IA), and Sheldon Whitehouse (D-RI) as cosponsors to the STOP Surprise Medical Bills Act, bringing the total cosponsors of the legislation to 14 senators. They join Cassidy along with U.S. Senators Michael Bennet (D-CO), Todd Young (R-IN), Maggie Hassan (D-NH), Lisa Murkowski (R-AK), Tom Carper (D-DE), Dan Sullivan (R-AK) and Sherrod Brown (D-OH).

This legislation is a product of a nearly year-long effort revising proposals and requesting feedback on draft legislation released last September by Cassidy, Bennet, Young and Carper—and legislation introduced last Congress by Hassan.

“Patients should be the reason for the care, not an excuse for the bill,” said Dr. Cassidy. “It’s exciting to see more of our Senate colleagues joining our effort to put patients first and end surprise medical billing.”

“Surprise medical billing is a convoluted process that leaves patients confused and their checking accounts emptied,” said Senator Cramer. “I am joining this bipartisan group of senators in supporting the STOP Surprise Bills Act because we need to protect patients’ pocketbooks and to ensure they are treated fairly, especially when they are most vulnerable.”

 “Patients facing an emergency health situation should not be doubly traumatized when they receive a bill for services,” said Senator Cardin. “I’m pleased to join this bipartisan effort.”

“This legislation protects patients and their pocketbooks from out-of-network bills. Having a medical procedure is stressful enough without getting hit with a surprise bill afterward. I’m happy to join legislation that helps patients,” said Senator Kennedy.

“The complexity of our health care system too often results in unexpected out-of-pocket expenses for patients,” said Senator Whitehouse. “I’m glad to join this bipartisan measure to ensure patients can focus on recovering from a health crisis without the looming worry of a surprise, life-altering medical bill arriving in the mail.”

“Throughout my 99 County Tour, I consistently hear from Iowans about the rising costs of healthcare, including many who receive unexpected bills following a visit to their doctor or hospital,” said Senator Ernst. “Hard-working folks in Iowa, and across the country, should be able to focus on getting the care they need, instead of negotiating surprise medical bills. This bipartisan legislation will increase transparency and protect patients from burdensome medical expenses.” 

Click here to see the section-by-section.

The STOP Surprise Medical Bills Act addresses three scenarios in which surprise medical billing (also known as “balance billing”) would be prohibited:

  • Emergency services:  The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.
  • Non-Emergency services following an emergency service at an out-of-network facility: This bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
  • Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.

Providers would automatically be paid the difference between the patient’s in-network cost-sharing amount and the median in-network rate for these services, but providers and plans would have the opportunity to appeal this payment amount through an independent dispute resolution process, should they see fit. This “baseball-style” process would entail the plan and provider submitting offers to an independent dispute resolution entity that has been certified by the Secretaries of HHS and the Department of Labor. This entity would make a final decision based upon commercially-reasonable rates for that geographic area.

The patient is completely removed from this process between the provider and the plan, and regardless of any outcome from a dispute resolution process, the patient still only owes the in-network rate. States that have established an alternate mechanism for protecting patients and determining payment amounts for providers would be able to continue with those systems.

study from the Georgetown University Health Policy Institute reviewed the implementation of a similar law to address surprise medical billing in New York. New York’s law takes patients out of the middle of payment disputes between providers and plans and uses a “baseball-style” approach to settle payment disputes when the providers and plans can’t reach an agreement on their own.

The study found that state officials have seen a “dramatic” decline in consumer complaints about surprise medical billing since the law went into effect, that independent arbitrator decisions were essentially even between plans and providers, and that the vast majority of cases were resolved before needing to go to arbitration. The study points out that the state law does not cover ERISA plans, underscoring the need for federal action.