Payer groups form coalition to push surprise billing reforms

Medical bill healthcare cost price patient spending
Payer groups have teamed up to push surprise billing policies. (Getty/everydayplus)

Two of the biggest insurance industry groups have teamed up to advocate for policies related to surprise billing. 

America’s Health Insurance Plans and the Blue Cross Blue Shield Association headline the Coalition Against Surprise Medical Billing, which was formally unveiled earlier this week. Other groups involved in the organization include the National Association of Health Underwriters and America’s Physician Groups. 

The coalition backs “common-sense reforms” to address surprise medical bills, which have been a dominant health policy topic of late, according to the announcement. Notably, it’s pushing for legislators to use a set rate for out-of-network services, a proposal that’s popular among payers who are skeptical of arbitration. 

Whitepaper

Elevate Health Plan Member Engagement Through Call Center Transformation

Learn how health plans can rapidly transform their call center operations and provide high-touch, concierge service to health plan members.

The coalition estimates that reforms like rate setting and offering patient protections for out-of-network emergency care could save more than $25 billion over the next decade. 

“By establishing patient safeguards for emergency care and the federal benchmark for rates, doctors and health insurance providers avoid the costly, bureaucratic arbitration processes that drive up premiums and increase costs for taxpayers and employers,” the group said in the announcement. 

RELATED: Trump calls on Congress to take action on surprise billing 

This position pits the coalition directly against major hospital groups, who have teamed up to support surprise billing policies as well.  

The American Hospital Association favors arbitration over set rates and has submitted several principles it hopes legislators consider in a surprise billing solution alongside the Association of American Medical Colleges, America’s Essential Hospitals and the Federation of American Hospitals. 

That these two wings of the industry are so strongly opposed has been frustrating to lawmakers, who at a hearing on Wednesday warned that if payers and providers can’t self-regulate, Congress will be forced to step in and find a solution that’s unlikely to please any of the industry players. 

“If ya’ll don’t want to solve it, we’re going to,” Rep. Markwayne Mullin, R-Oklahoma, said in the hearing. “All we’re saying is: 'Do it. Solve it.'” 

The payer-led coalition intends to issue advertisements in Washington, D.C., and nationally via social media in the coming weeks to oppose arbitration and push for other types of reforms. 

Suggested Articles

Nearly 10,000 patients involved in research studies were impacted by a third-party privacy breach that may have exposed their medical diagnoses, test results…

Employers looking to continue investing in their wellness programs are eyeing services targeting mental health and women’s health, a new survey shows.

Payers have made strides digitizing and automating many core processes, yet prior authorization remains a largely manual, cumbersome process.