Should we add protections for out-of-network healthcare bills?
Bill Summary
This bill amends the Public Health Service Act to better protect people from surprise billing practices. H.R. 3630 would restrict insurers ability to charge people out-of-network rates on services. Included in this are regulations on how much can be charged for emergency services and additional costs that can be billed to people after seeing out-of-network providers.
Sponsor: Rep. Frank Pallone (Democrat, New Jersey, District 6)
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Opponents say
• “[Texas Medical Association] is adamantly opposed to the current proposal which uses a median in-network reimbursement rate as the de facto rate for out-of-network services, as this allows the health plans to unilaterally and unfairly control payment rates. TMA instead prefers an independent dispute resolution where there is an impartial party that helps determine a fair resolution between physicians and health insurers.” - David Fleeger, President of the Texas Medical Association
• “What Congress is considering would cut money that vulnerable patients rely on the most. That means seniors, children, and Americans who rely on Medicaid would be hurt. … Tell Congress we can end surprise billing without shredding the safety net.” - Physicians for Fair Coverage
• “What Congress is considering would cut money that vulnerable patients rely on the most. That means seniors, children, and Americans who rely on Medicaid would be hurt. … Tell Congress we can end surprise billing without shredding the safety net.” - Physicians for Fair Coverage
Proponents say
• “From the outset, our top priority has been to hold patients harmless in situations where, through no fault of their own, they receive a surprise bill from an out-of-network healthcare provider, and that’s exactly what the No Surprises Act will do… With this strong, bipartisan vote, the days of patients receiving financially devastating surprise health care bills are numbered. The No Surprises Act will shield consumers from these outrageous billing practices while striking a fair balance between the stakeholders who have allowed this clear market failure to persist for decades at the patients’ expense.” - Rep. Frank Pallone (Democrat, New Jersey, District 6) and Rep. Greg Walden (Republican, Oregon, District 2)
• “We need to ensure that all patients, who are trying in good faith to work through our convoluted system to receive care and pay their bills, are not victimized when providers and insurers cannot agree. At the same time, we need to ensure we aren’t harming rural providers in the process” - Rep. Greg Gianforte (Republican, Montana, At-Large District)
• “Too often, patients can do their due diligence to ensure their provider is in-network, only to be hit with a surprise medical bill down the line… For example, when you go to the hospital for a colonoscopy, you’re not only working with a gastroenterologist, but also an anesthesiologist and perhaps a pathologist. If one of those providers isn’t in your insurance network, your bill could be astronomical. We must change the current system, which is why I voted for the No Surprises Act and look forward to continuing to work on this issue.” - Rep. Brett Guthrie (Republican, Kentucky, District 2)
• “We need to ensure that all patients, who are trying in good faith to work through our convoluted system to receive care and pay their bills, are not victimized when providers and insurers cannot agree. At the same time, we need to ensure we aren’t harming rural providers in the process” - Rep. Greg Gianforte (Republican, Montana, At-Large District)
• “Too often, patients can do their due diligence to ensure their provider is in-network, only to be hit with a surprise medical bill down the line… For example, when you go to the hospital for a colonoscopy, you’re not only working with a gastroenterologist, but also an anesthesiologist and perhaps a pathologist. If one of those providers isn’t in your insurance network, your bill could be astronomical. We must change the current system, which is why I voted for the No Surprises Act and look forward to continuing to work on this issue.” - Rep. Brett Guthrie (Republican, Kentucky, District 2)
- Pallone & Walden on Committee Passage of No Surprises Act (Press Release)
- Dark Money Group Brings Provider-Insurance Battle to Texas TV Screens (KXAN)
- Surprise! Congress Might Actually End Big, Unexpected Medical Bills (The Washington Post)
- 1 in 7 Patients Get Surprise Bill After In-Network Hospital Care, HCCI Finds (Healthcare Dive)
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