May 16, 2019

Senators Hassan, Cassidy, and Bipartisan Group of Senators Introduce Legislation to End Practice of Surprise Medical Bills for Granite Staters and Americans

WASHINGTON – Senators Maggie Hassan (D-NH), Bill Cassidy (R-LA), and a bipartisan group of Senators introduced bipartisan legislation today to end the practice of surprise medical bills. The Senators announced the introduction of the bipartisan STOP Surprise Medical Bills Act along with Michael Bennet (D-CO), Todd Young (R-IN), Lisa Murkowski (R-AK), and Tom Carper (D-DE), at a press conference today. U.S. Senators Dan Sullivan (R-AK) and Sherrod Brown (D-OH) are also cosponsoring the bill.

Senator Hassan has been a leader in efforts to address surprise medical bills and has been working for months with members from both parties to craft this bipartisan legislation. As part of those efforts, the bipartisan group sought feedback from health care providers and insurers. Last Congress, Senator Hassan introduced legislation to eliminate surprise medical bills and brought Donna Beckman of Seabrook, who faced a surprise medical bill, as her State of the Union guest to raise awareness for the issue. The Senator has also met with Granite Staters to hear about their own personal experiences receiving surprise medical bills.

This bipartisan legislation would build on the laws passed by New Hampshire and other states to prevent surprise medical billing. According to the Kaiser Family Foundation, nearly 60 percent of workers who have health insurance through their jobs have self-insured plans that are regulated federally, not by states, underscoring the need for federal protections for patients.

“People get health insurance so they won’t be surprised by health care bills,” Senator Hassan said. “It is outrageous and completely unacceptable that people in New Hampshire and across the country do everything they’re supposed to in order to ensure that their care is in their insurance network and then still end up with large, unexpected bills from an out-of-network provider. There is strong bipartisan momentum behind ending the absurd practice of surprise medical bills and I am hopeful that we can pass this legislation and get it signed into law without delay.” 

“Patients should be the reason for the care, not an excuse for the bill,” said Dr. Cassidy. “We have worked for almost a year with patient groups, doctors, insurers and hospitals to refine this proposal. This is a bipartisan solution ensuring patients are protected and don’t receive surprise bills that are uncapped by anything but a sense of shame.”

“This bipartisan proposal would ensure that no patient will ever again be subject to outrageously high ‘surprise bills’ as the result of a hospital visit,” said John Rother, President and CEO of the National Coalition on Health Care. “Americans should have confidence that they will be treated fairly the next time they visit an emergency room. The National Coalition on Health Care commends Senators Cassidy and Hassan for their leadership on this issue, and we urge swift consideration by the Congress. Health care is expensive enough without families being subjected to price gouging just when they are most vulnerable.

“We work every day with patients who have done everything right—have insurance, inquire about network status—but they're still caught in the middle of a system over which they have no control. They still wind up with enormous surprise bills,” said Alan Balch, CEO of the National Patient Advocate Foundation. “We are excited to see lawmakers working together to create a more fair system for patients and their families.”

There is bipartisan momentum behind eliminating surprise medical bills, and last week, Senators Hassan and Cassidy joined President Trump at a White House event on the need to address this issue.

Click here to see the section-by-section.

The STOP Surprise Medical Bills Act addresses three scenarios in which surprise medical billing (also known as “balance billing”) would be prohibited:

  • Emergency services:  The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.
  • Non-Emergency services following an emergency service at an out-of-network facility: This bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
  • Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.

Providers would automatically be paid the difference between the patient’s in-network cost-sharing amount and the median in-network rate for these services, but providers and plans would have the opportunity to appeal this payment amount through an independent dispute resolution process, should they see fit. This “baseball-style” process would entail the plan and provider submitting offers to an independent dispute resolution entity that has been certified by the Secretaries of HHS and the Department of Labor. This entity would make a final decision based upon commercially-reasonable rates for that geographic area.

The patient is completely removed from this process between the provider and the plan, and regardless of any outcome from a dispute resolution process, the patient still only owes the in-network rate. States that have established an alternate mechanism for protecting patients and determining payment amounts for providers would be able to continue with those systems.

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