Surprise Medical Billing

Policy Reference:

The Issue

The U.S. Senate and House are both considering legislation to address surprise medical bills that patients may incur as a result of unexpected gaps in insurance coverage or medical emergencies.

To date, both the Senate Committee on Health, Education, Labor and Pensions and the House Energy and Commerce Committee have passed bills seeking to address surprise medical bills. 

The Senate Health, Education, Labor and Pensions (HELP) Committee reported out legislation to prohibit balance billing to patients in most circumstances, but allows insurers to pay providers a benchmark rate for the remaining bill.  This is in lieu of negotiating with the hospital for the out-of-network fee as is current practice.

The House Energy and Commerce Committee reported out similar legislation, banning the balance billing to patients and providing a set benchmark rate, but also allowed for arbitration of the remaining fee if the bill exceeds $1,250. 

Our Position

Munson Healthcare is firmly committed to relieving patients of surprise medical bills. MHC endorses legislative efforts to prohibit patients from out-of-pocket expense beyond the in-network deductibles and co-pays of their insurance plan. However, we are opposed to legislative provisions that set prices for resolving the balance of the out-of-network payment between the insurer and provider.

What You Can Do

Please consider contacting your member of Congress and U.S. Senators to ask them to:

Protect patients from surprise bills that they may incur as a result of unexpected gaps in insurance coverage or medical emergencies.

  • Patients should not be balance billed for emergency services or for out-of-network services obtained in any in-network facility when they reasonable could have assumed that the providers were in-network with their health plan.

Allow providers and insurers to negotiate payment rates for services provided after the patient is protected.

  • Congress should not impose arbitrary rates on providers.  This type of price setting would compromise patient access to care and create a disincentive for insurers to maintain adequate provider networks, particularly in our rural area.

Reject provisions that are not related to surprise billing in this legislation, including unworkable price transparency proposals and policies that impede provider and health plan contracting.

  • Congress should focus on protecting patients from surprise medical bills and not include other provisions that could limit access to patient care and have unintended, negative consequences on the healthcare system.