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WASHINGTON -- After two years of debate in four congressional committees, Congress seemed likely to pass bipartisan legislation Monday that, if signed into law, will protect millions of consumers from unfair surprise medical bills from out-of-network providers. These surprise bills come from balance billing -- when out-of-network medical professionals charge you the difference between their fees and the maximum amount allowed by your insurance company.
Although the compromise bill was further amended Sunday, a report on the changes makes it appear that the key protections won by consumers remain in place. The bill is expected to pass both houses of Congress Monday as part of a larger spending package.
In response to the expected congressional passage of the surprise billing legislation, Patricia Kelmar, U.S. PIRG’s Health Care Campaigns director, made the following statement:
“If passed, this will be the most far-reaching consumer protection that Congress has passed in recent memory. Even before COVID hit our shores, more than two-thirds of consumers worried about getting a surprise medical bill they couldn’t afford. And they were right to be concerned. In fact, there’s a one in five chance that we’ll be hit with a surprise medical bill after receiving care in a hospital or emergency room. We only find out that these providers and services aren’t covered by our insurer after the fact -- when we’re home recovering and the surprise bill of hundreds or even thousands of dollars arrives.
“Congress is expected to finally act today to protect consumers from this unfair billing practice. If this legislation is passed and signed into law, it will protect millions of insured Americans from outrageous surprise bills sent by out-of-network hospitals, providers and air ambulances.
“To prevent out-of-network billers from simply charging our insurance companies instead, which could increase our premiums, the new law would set up an arbitration system to resolve payment disputes between providers and health insurance plans. Analysis shows that this could reduce those out-of-network payments by insurers significantly -- by up to 15-20 percent.
“It’s a long-awaited, common-sense solution for an expensive problem that has been harming consumers for too long.
“Private-equity backed physician staffing firms and other opponents have been spending millions of dollars to stop or weaken this bill. As a result, it’s not exactly the legislation we called for. So, we’ll work hard to ensure stronger regulations are eventually put in place and we’ll monitor this law's impact on costs in the years ahead.
“If this bill passes today, we'll be gratified that Congress heard and respected consumer voices. And Americans in every state can cheer for this consumer victory.”
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