Employers Push Surprise Billing Solution in Next COVID-19 Relief Bill

Business Group on Health and others urge Congress to make permanent a ban on balance billing of patients and require payment disputes to be tied to local market rates.

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In early July, Business Group on Health joined other employer groups and union representatives in a joint letter to Congress making the case for a comprehensive surprise billing solution as they consider another COVID-19 relief package. The letter complements similar letters from consumer groups asking for the same thing.

Payer and patient groups want Congress to ensure that not only are patients not billed more than in-network rates for unplanned out-of-network care (either in emergencies or for care at in-network facilities), but also that disagreements between providers and payers be settled using local market rates as a guide. Providers prefer arbitration to settle disputes, which payers view as creating uncertainty and likely to be inflationary.

Competing bills, backed by payers and consumers on one side and providers on the other, have stalled movement in both the House and Senate. A compromise, supported by the Business Group, was agreed to by the Senate Health, Education, Labor and Pensions (HELP) and the House Energy and Commerce Committees that would ban balance billing of patients and also ensure that a benchmark rate tied to locally negotiated rates for the same service would be used for payment if plans and providers could not agree on a price. Its provisions are still under consideration by members of Congress sympathetic to patients and payers’ concerns.

This latest push follows action by the Administration to link COVID-19 aid to a commitment by the health sector to not balance bill patients during the public health emergency. Given the disruption in networks and the financial impact on providers and patients due to the pandemic, the likelihood of surprise bills for health care may increase. Therefore, it is even more critical for Congress to take action to solve this growing problem.

Click here for the Business Group’s position statement on surprise billing.

What's Next?

Congress is expected to take up another COVID-19 relief bill before August that could include additional provisions limiting surprise billing. While it is unclear whether such provisions will be included, it is a growing issue on people’s minds. Prior to the pandemic, surprising billing was identified by polls as an important issue to voters.

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We provide this material for informational purposes only; it is not a substitute for legal advice.

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