Even though the COVID-19 pandemic has taken center stage in Congress, a collection of business and health groups are imploring lawmakers to not forget about another priority: surprise medical bills.
Before the pandemic, the fight over surprise billing was the biggest healthcare issue before Congress. Progress has stalled amid an intense lobbying war between providers and payers over how to pay providers for out-of-network charges.
Now, a collection of unions, business groups and policy institutes wrote to congressional leaders Wednesday asking for a provision on surprise medical bills to be included in the next coronavirus stimulus package.
“We urge you to end surprise medical billing for all patients through the implementation of fair, market-based payments for out-of-network charges,” the letter said.
The American Benefits Council, the AFL-CIO, the Business Group on Health and the American Health Policy Institute were among the groups that signed on to the letter. But the letter’s idea to handle out-of-network charges is sure to renew disputes among providers and payers.
The letter calls for Congress to align out-of-network charges to “local, privately negotiated amounts.”
“According to the Congressional Budget Office, linking out-of-network reimbursement to the median in-network payment would save consumers and taxpayers nearly $25 billion over the next ten years,” the letter said.
But the endorsement of a “benchmark” rate is sure to rankle providers, which instead endorse an arbitration method where the hospital and insurer submit an amount for an out-of-network charge and a third party chooses an amount.
Providers are worried that insurers could game a "benchmark" rate to underpay them, while insurers argue arbitration could lead to higher costs for consumers.
The dispute has stalled any progress on the issue, which has widespread bipartisan support. At the end of last year, House and Senate lawmakers reached a compromise that would use a benchmark rate but would trigger an arbitration “backstop” for any charges more than $750.
Provider groups such as physician staffing group Envision Healthcare blasted the inclusion of a benchmark rate.
But that effort failed to get included in a must-pass spending package after opposition emerged from the House Ways and Means Committee. The panel created its own method that uses a mediation process similar to arbitration.
Mediation would trigger if hospitals and insurers can’t come to an agreement on an out-of-network rate after 30 days.
However, the onset of the COVID-19 pandemic in March effectively put any talk of surprise billing on the back burner.
While there were reports that some lawmakers wanted to include a surprise billing provision in previous coronavirus stimulus legislation, no provision was added.
It also remains unclear when Congress will approve another round of stimulus funding. While the House has passed a $3 trillion stimulus package, Senate Republicans have not taken it up because they want to see the impact of funding that was already approved.
The House bill, called the HEROES Act, does ban surprise billing for any COVID-19 patients, but not for all payments.