Statement: Congressional compromise would end surprise medical billings

Advocates urge passage of the bipartisan compromise to protect consumers

U.S. PIRG

WASHINGTON — In a surprise agreement after months of deadlock, congressional committee leadership has announced compromise language on legislation to end surprise medical bills. For two years, four congressional committees have worked on solutions to protect consumers from surprise medical bills from out-of-network providers. These surprise bills come from balance billing — when medical professionals charge you the difference between their fees and the maximum amount allowed by your insurance company.

The issue that caused the most debate was how to determine a fair payment for out-of-network providers without raising overall health care costs. The compromise bill, the End Surprises Act, establishes an independent dispute resolution process that uses the median in-network provider rates as a key factor. Congressional leaders expressed hope to pass this new compromise legislation in the coming days.  

In response to the compromise language, Patricia Kelmar, U.S. PIRG’s Health Care Campaigns director, made the following statement:

“Surprise medical bills are the worst kind of surprise at the worst possible time, far too often. One in five insured adults gets stuck with a surprise bill for hundreds or even thousands of dollars after visiting the hospital or emergency room. Even when consumers seek care from a hospital covered by their health plan, an out-of-network provider can send a huge bill. 

“Twenty-nine states have already put limits on surprise billing to solve this problem but we need a federal law to protect all Americans. We are gratified that this bill’s congressional sponsors stayed at the table to negotiate a winning compromise around this key consumer protection measure. 

“Although the bill isn’t exactly what we hoped for, it does protect consumers from surprise bills sent by out-of-network  hospitals, providers and air ambulances. And, it allows stronger state laws to remain in effect. 

“Because the bill allows for an arbitration system to settle payment disputes between plans and providers, it isn’t the most efficient way to solve the problem. Too much reliance on arbitration may work against our goal to keep overall costs down. But we’ll work hard to ensure strong regulations are put in place and we’ll monitor the law’s impact on costs in the years ahead. 

“Consumers have waited too long for protection from unfair surprise medical bills. If this compromise solution is the only way to see it enacted this year, then we ask congressional leadership to make it a priority and pass the End Surprises Act now.  

“Congressional cooperation is always a welcome surprise, for the holiday season and year-round.”