U.S. Rep. Larry Bucshon (R-IN) last week released a draft of legislation that would provide protections against balanced billing, which is also known as surprise billing.
“Access to life-saving care is critical for all Americans and it should not come with lifelong penalties,” Rep. Bucshon said.
The lawmaker on May 23 offered a section-by-section summary of what will be known as the Protecting People from Surprise Medical Bills Act, which would ban surprise billing and would prevent patients from being involved in resolving any payment disputes.
“As a physician, I believe it is important that patients are not financially burdened with surprise medical bills for unanticipated out-of-network care,” said Rep. Bucshon. “Instead of picking winners and losers, I support this bipartisan proposal that offers an independent dispute resolution process that is mediated by an arbiter.”
Specifically, the bill would disallow out-of-network (OON) providers to balance bill a patient for unanticipated OON care, which includes emergency care in both in-network and OON facilities; scheduled anticipated care with unanticipated OON providers; OON after-emergency care when a patient cannot travel without medical transport; and OON imaging or lab services when ordered by an in-network provider, according to the summary.
The Protecting People from Surprise Medical Bills Act also would require providers and insurers that disagree on a payment rate to engage in an independent dispute resolution process in which insurers and OON providers each would identify a cost for the patient’s care and a neutral arbiter would decide the best price, according to the summary.
Additionally, the forthcoming bill would improve transparency by requiring health plans to clearly identify in-network providers and patients’ deductibles, among other provisions provided in the summary.
The bill is expected to be introduced soon, according to Rep. Bucshon’s office.