The 116th Congress has started with a flurry of activity on legislation to address “surprise,” or “out-of-network,” billing, which continues Senate efforts that began on the issue last fall. Broadly, out-of-network billing occurs when one or several providers for a particular episode of care are outside of a patient’s insurance network. In emergency medicine, this situation can occur even when the hospital in question participates in the patient’s health insurance network as other providers providing care to the patient in the emergency department, such as anesthesiologists, emergency physicians, and radiologists, may be out of network for the patient. This situation can result in a patient receiving one or more medical bills that are not covered by their insurance carrier.

In general, legislative proposals to date have attempted to remove the patient from the situation of receiving multiple bills, instead proposing systems where insurers and providers interact to resolve a billing issue. Such proposals include setting rates for care based on geographic area and tied to Medicare or other public payor rates, creating dispute resolution systems, such as arbitration, to settle differences between providers and insurers, or bundling all forms of treatment for an emergency episode into a single hospital charge.

Thus far, three committees in the House of Representatives have shown interest in the issue, including the House Ways & Means Committee, House Energy & Commerce Committee, and House Education & Labor Committee, with the Education & Labor Committee’s Subcommittee on Health, Employment, Labor, and Pensions holding a hearing to discuss the issue on April 2. Despite such interest, legislation has not yet been introduced to tackle the issue in the House of Representatives. By contrast, the U.S. Senate has taken a more active approach, with several senators, including Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.), Michael Bennet (D-Colo.), Todd Young (R-Ind.), Tom Carper (D-Del.), and Lisa Murkowski (R-Alaska), soliciting information from outside stakeholders about the issue. In addition, Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) have sent several options to the Congressional Budget Office (CBO) to understand their overall cost. Ultimately, the Senate is looking to introduce comprehensive legislation the issue in the summer.


Recent Newsletter Stories