ASCP Supports Legislation Protecting Patients from Surprise Billing

The Senate Health, Education, Labor and Pensions (HELP) Committee on June 26 approved a measure addressing surprise medical billing, which often occurs in hospital settings when patients receive out-of-network medical bills from providers they were unaware were not in their network. The legislation, called the “Lower Health Care Costs Act,” includes some positive proposals, but also includes some proposals seen as unfavorable to providers. Specifically, it requires insurers to disclose in-network provider options to help patients make more informed decisions about where to seek care. Unfortunately, the measure would also cap out-of-network provider reimbursement at payers’ “in-network” rate, which would undermine the ability of physicians to negotiate more favorable payment rates. In addition, the measure lacks a binding arbitration provision as a means to resolve disputes between providers and insurers, and keep patients out of the middle of these disputes.

In contrast, legislation is being developed in the House of Representatives that is based on the approach used in New York state. This bill, the “Protecting People from Surprise Medical Bills Act of 2019,” includes an independent dispute resolution process. It bases reimbursement on the rate for that service in the geographic area, based on an independent non-conflicting database of commercial charges. The approach is being supported by providers, including ASCP members, as providing important patient protections while also being more likely to provide fair reimbursement rates for providers.

ASCP has been tracking the issue of surprise billing for quite some time (see our 2017 policy statement for more information). The U.S. Department of Health and Human Services reached out to ASCP for our perspective on this issue in March, citing our patient-centric approach. We have long advocated for 1) adequate insurance networks and transparency; 2) holding patients harmless; and 3) adequate reimbursement for pathologists. Additionally, we’ve worked with other organizations, such as the American Medical Association and College of American Pathologists, to ensure patients are held harmless and protected from surprise medical bills.

ASCP will continue to track this issue as a legislative fix gains momentum and will keep members apprised of further developments as they arise.

Other articles in ePolicy News July 2019

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

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