Congress Announces Consensus to End Surprise Medical Bills

Members of both parties and in both chambers of Congress have reached a consensus on a bill that aims to protect patients from receiving surprise medical bills by prohibiting hospitals and healthcare providers from charging fees that a patient’s insurance will not cover and preventing patients from being billed when they receive emergency services from a provider that is not part of their network.

Called the “No Surprises Act,” members of the House Energy and Commerce Committee, House Ways and Means Committee, House Education and Labor Committee, and Senate Health, Education, Labor and Pensions Committee announced the compromise late last week. A summary of the bill is available by clicking here.

“Under this agreement, the days of patients receiving devastating surprise, out-of-network medical bills will be over,” Congressional leaders said in a joint statement. “Patients should not be penalized with these outrageous bills simply because they were rushed to an out-of-network hospital or unknowingly treated by an out-of-network provider at an in-network facility.”

Under the bill, patients would only be responsible for the in-network cost-sharing responsibilities, such as deductibles and co-pays, while insurance companies and healthcare providers would negotiate the remaining unpaid portions of a patient’s bill. Among the other provisions of the bill are:

  • Requires health plans to offer a price comparison tool for consumers
  • If a patient receives a bill more than 90 calendar days after receiving care, the patient is not obligated to pay.
  • Requires health plans to provide an Advance Explanation of Benefits for scheduled services at least three days in advance to give patients transparency into which providers are expected to provide treatment, the expected cost, and the network status of the providers.

The American Hospital Association was less-than-thrilled with the provisions of the bill. The AHA has “significant concerns with several of the provisions that would attempt to implement unworkable billing processes and transparency provisions that are duplicative and costly without clear added benefit for patients,” it said in a statement.

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