House and Senate panels reach provider-friendly deal to end surprise medical billing

Capitol building in Washington
House and Senate committee leaders reached a pivotal deal to end surprise medical bills and hope to include it in an end-of-year spending package. (rarrarorro/iStock/Getty Images Plus/Getty Images)(Photo by rarrarorro/iStock/Getty Images Plus/Getty Images)

A deal to end surprise medical bills includes a major win for the provider industry with lawmakers endorsing an arbitration method for settling out-of-network disputes.

Leaders of several major House and Senate committees announced a deal Friday night to end a yearlong stalemate over how to end surprise medical bills. The deal is a win for providers that wanted an arbitration resolution for out-of-network charges and a loss for payers who endorsed a benchmark rate for such charges.

The committee leaders said they “look forward to continuing to work together to finalize and attach this important new patient protection to the end-of-year funding package.”

The deal would prohibit certain out-of-network providers from balance billing patients unless the patient is notified of their network status, according to a release on the deal. The patient also has to have an estimate of any charges 72 hours prior to getting the out-of-network care.

Out-of-network charges will be based on a negotiation between payers and providers.

“There is no minimum payment threshold to enter [independent dispute resolution] and claims may be batched together to ease administrative burdens,” the release added.

The parties have to submit an offer to an independent arbiter who will choose one of the amounts.

After the process is completed, the payer or provider that initiated the dispute can’t take the same party “to arbitration for the same item or service for 90 days,” the release said.

The deal effectively ends a yearlong stalemate between the House committees on Energy and Commerce, Ways and Means, and Education and Labor along with the Senate Health, Education, Labor and Pensions (HELP) Committee.

Energy and Commerce and HELP reached an agreement late last year to use a benchmark rate that had an arbitration backstop if the charge goes over $750. But the deal drew opposition from Ways and Means and Education and Labor, which favored a more provider-friendly approach.

It remains unclear whether congressional leadership will include the deal in an end-of-year spending package that Congress must approve by Dec. 18 to avoid a government shutdown.

If the deal is included, it would bring an end to a massive lobbying war ignited by providers and payers over how to end surprise medical bills.