Today, the Committee on Education and Labor advanced the Ban Surprise Billing Act (H.R. 5800), a bipartisan proposal to protect patients from devastating surprise medical bills. The legislation builds on various bipartisan solutions to shield patients from unexpected out-of-pocket health care costs.
"The fear of an unexpected medical bill can be paralyzing, and we as elected Representatives cannot sit idly by as American families forgo care they need for fear that they’ll end up responsible for an unexpected, unaffordable surprise medical bill," said Republican Leader Virginia Foxx. "Workers and families deserve certainty about their health care coverage, and by taking action today and advancing the Ban Surprise Billing Act, we move one step closer to giving patients financial confidence. I thank Chairman Scott for working in a bipartisan fashion to shield American families from financially devastating surprise medical bills."
“Surprise medical billing is a troubling and all-too-common product of our complex health care system. The status quo is unacceptable. Patients are getting hit with astronomical bills and both payers and providers are facing an uncertain future,” said Chairman Scott. “The Ban Surprise Billing Act is a bipartisan solution that protects patients from unexpected, often significant out-of-pocket costs while being fair to both providers and payers. I want to thank Dr. Foxx and all members of the Committee for working together to advance a proposal that provides patients and their families the consumer protections they deserve.”
The Ban Surprise Billing Act provides important consumer protections for Americans who receive health care coverage through their employer and for those enrolled in the individual market. The bill:
Protects patients from receiving surprise bills by limiting cost-sharing to their plan’s in-network rate and prohibiting out-of-network providers from sending balance bills that exceed the in-network rate;
Protects air ambulance patients and takes steps to address ground ambulance surprise bills;
Builds on various bipartisan agreements for resolving payment disputes between providers and payers;
For amounts less than or equal to $750 (or $25,000 for air ambulance services), relies on a market-based benchmark of the median in-network rate of providing similar items or services in the same geographic area; and
For amounts above $750 ($25,000 for air ambulance services), providers and payers may elect to use independent dispute resolution (IDR) to determine a fair payment amount.
The Ban Surprise Billing Act also includes several bipartisan reforms to improve transparency so patients can better understand their coverage, including:
Requires health plans to maintain up-to-date and accurate provider directories;
Improves consumer access to information regarding expected cost-sharing; and,
Improves transparency regarding in-network and out-of-network deductibles and out-of-pocket limitations.
The bill, led by Ranking Member Virginia Foxx (NC-05) and Chairman Robert C. “Bobby” Scott (VA-03), advanced through Committee 32-13.
To read the fact sheet on the Ban Surprise Billing Act click here.