Surprise billing efforts stall in Congress

Medical bill healthcare cost price patient spending
Bipartisan efforts to tackle surprise medical bills have hit a major snag in Congress as providers are fighting over how they will get paid. (Getty/everydayplus)

Surprise billing at one point appeared to be a slam-dunk bipartisan issue that Congress could tackle this year. But nearing the end of 2019, a major dispute over how to pay providers has stalled momentum.

Committees in the House and Senate have both advanced legislation that would prohibit balance billing, in which the provider bills the patient for what their insurance won't cover. It would instead use a benchmark median rate for all out-of-network charges.

Providers, however, want to use “baseball style” arbitration in which both provider and payer submit the amount they want for an out-of-network charge. Provider groups, some of which are backed by private equity firms, launched a major ad blitz over the summer against the benchmark approach.

Congress is now pondering how to move forward.

RELATED: One reason surprise billing solutions are so tricky for hospitals

The chairman of the House Ways and Means Committee, Rep. Richard Neal, D-Mass., is floating a compromise that would use “negotiated rulemaking,” in which a trio of federal agencies develop the benchmark rates after a public comment period.

But some in the insurance industry are already shooting that compromise down.

“These are very protracted processes, and at the end of the process there is no guarantee the outcome of that rule will not be questioned,” said Kris Haltmeyer, vice president of legislative and regulatory policy for the Blue Cross Blue Shield Association, in a recent briefing with reporters. “There is a question if Congress has the authority to kick substantial decisions to rulemaking.”

The association, which represents 36 blues insurers, was also opposed to any compromise that enables arbitration.

“In arbitration, you will likely get higher reimbursements that will have to reflect in premiums,” Haltmeyer said.

There is still a chance for a surprise billing fix to move at the end of the year as part of a larger healthcare package, said Elizabeth Carpenter, head of advisory services at the consulting firm Avalere. 

"Surprise medical bills is one of the top issues on the minds of voters, but politically it is a very challenging issue of Congress," she said.

Surprise billing efforts stall in Congress