Surprise Medical Bill Legislation Takes A Step Forward, But Will It Lead To A Step Back?

The House Energy and Commerce Committee Wednesday approved its version of legislation to curb surprise medical bills. Though this step was an important advance, there’s still a long way forward before Congress agrees on a legislative solution to this high-profile consumer concern.

These bills, the unexpected and often high charges patients face when they get care from a doctor or hospital that isn’t in their insurance network, have been the hot issue on Capitol Hill for months. Lawmakers on both sides of the aisle have been tripping over themselves to address the widely loathed problem.

One of the existential questions of the debate has been how to compensate health care providers if balance billing — which is what happens when patients are responsible for the costs not covered by their insurer — is prohibited.

The bill before Energy and Commerce originally included what’s known as “benchmarking” to set the payment amount for out-of-network doctors. So, instead of sending patients a bill for the amount that their health plans don’t pay, a doctor would be forced to accept an amount that is the average of what other doctors in the area are paid for the procedure.

This approach has been favored by groups representing employers and insurance plans but draws disdain from medical specialty provider groups. Those doctor organizations, which include specialists like emergency physicians and anesthesiologists, prefer arbitration, sometimes called “independent dispute resolution.” Under that system, both the insurer and provider would propose an amount to an independent third party, who would pick one of the two prices. The loser then pays the costs of the arbitration.

Though it’s a tidy compromise between the positions, it means the House bill no longer matches the primary legislation moving through the Senate, which earlier this summer gained the approval of that chamber’s Health, Education, Labor and Pensions (HELP) Committee  That bill exclusively favors benchmarking. Still, staffers are optimistic that bill can still pass before the Senate leaves D.C. for its August recess.