October 18, 2018

Health Affairs on Senator Hassan’s Surprise Medical Bills Legislation: “Hassan’s bill would nearly eliminate surprise out-of-network bills for enrollees in employer-provided health plans”

WASHINGTON – In case you missed it, Health Affairs published a piece today on Senator Maggie Hassan’s No More Surprise Medical Bills Act, which she introduced to help address surprise medical bills, where patients receive massive, unexpected medical bills, often for receiving care that they didn’t realize was considered out-of-network.

The authors of the Health Affairs piece write of the Senator’s bill: “The No More Surprise Medical Bills Act should be applauded for tackling an important problem in a thoughtful manner. As written, Hassan’s bill would nearly eliminate surprise out-of-network bills for enrollees in employer-provided health plans.” 

The No More Surprise Medical Bills Act of 2018 would help eliminate surprise medical bills for people with employer-sponsored health plans. The bill will protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount. The bill also protects patients in non-emergency situations from surprise bills by requiring hospitals and providers to notify patients if services will be out-of-network and get their consent. Without proper notification and consent, a provider can only charge a patient the in-network amount. If payment disputes arise when these rules aren't followed, the legislation would establish an independent entity to resolve disputes between providers and health insurance plans, without putting patients in the middle. This dispute resolution system is based on a "baseball-style" or “final offer” model, where the provider and insurance plan submit their best and final offer, and the independent entity must choose one of the offers. This model helps incentivize providers and plans to come to a reasonable amount.

See below for highlights of coverage or click here:

Health Affairs: Analyzing Senator Hassan’s Binding Arbitration Approach To Preventing Surprise Medical Bills

Another Senate bill to address the scourge of surprise out-of-network medical bills was newly released on October 12, the No More Surprise Medical Bills Act of 2018, this time introduced by Senator Maggie Hassan (D-NH) and cosponsored by Senator Jeanne Shaheen (D-NH).

…For enrollees in employer-sponsored health plans, the bill takes a largely similar approach to the recent bipartisan Senate bill, taking the patient out of the middle of the dispute and protecting patients in both emergency and nonemergency situations. The big difference is that, instead of prescribing a minimum payment rate from insurer to provider, Senator Hassan’s bill sets up a “binding arbitration” process to determine the appropriate provider payment rate in surprise out-of-network scenarios. And importantly, the arbiter would be instructed to consider Medicare and negotiated network rates, rather than artificially high provider charges, in making their rate determination.

…Hassan’s proposal would protect patients from surprise bills in both emergency situations and nonemergency situations at in-network facilities, when they are seen unexpectedly by an out-of-network clinician. An exception is allowed if the out-of-network provider provides an estimate of costs and obtains both written and verbal consent from the patient more than 24 hours in advance. If timely patient consent was not obtained, then the legislation’s surprise out-of-network billing protection automatically kicks in and the patient can be charged no more than what they would have paid if the service were performed by an in-network provider.

Rather than prescribing the payment rate from insurer to provider for surprise out-of-network services, Hassan’s bill sets up a binding, “baseball-style” arbitration process to resolve payment disputes if the two parties are unable to agree on a payment amount. In this process, the insurer and provider each make a final offer and an independent arbiter contracted by government then chooses which of the two options it considers more reasonable. The theory behind this approach is that it incentivizes each side to make a reasonable offer or settle beforehand, because the arbiter is unlikely to choose an unrealistic offer.

…Senator Hassan’s bill improves options for states because currently they are unable to protect patients enrolled in self-insured employer health plans due to pre-emption by the Employee Retirement Income Security Act (ERISA).

…The No More Surprise Medical Bills Act should be applauded for tackling an important problem in a thoughtful manner. As written, Hassan’s bill would nearly eliminate surprise out-of-network bills for enrollees in employer-provided health plans.

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