Federal Update on Surprise Billing

The House Ways and Means Committee issued an outline of a bipartisan proposal for addressing surprise medical bills. This committee’s approach offers improvements over the recently issued agreement reached between the House Energy & Commerce Committee and the Senate Health, Labor, Education, and Pension (HELP) Committee.

  • Like other proposals, the Ways & Means plan would limit patients’ out-of-pocket costs to the amounts they would have owed if they had the opportunity to choose in-network physicians and facilities to provide their care.
  • An independent dispute resolution (IDR) system is also included. However, unlike other proposals, Ways & Means does not restrict IDR to claims above a certain threshold amount, nor does it establish a payment benchmark based on in-network payment amounts.
  • Price and network transparency provisions and protections for patients whose provider networks change during the plan year are also included. Uninsured or cash-paying patients would also have access to IDR if they are given misleading cost information prior to obtaining services.

After the outline was released, Committee chair Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) both affirmed their commitment to advancing a balanced approach to address surprise billing early next year, noting that the issue is too complex and important to rush through Congress prior to the holiday recess.