Lawmakers Commit to Pushing Legislation that Stops Surprise Medical Billing

Senate Health, Education, Labor and Pensions Committee Chairman Sen. Lamar Alexander (R-Tenn.) sitting next to the committee's ranking member Sen. Patty Murray (D-Wash.), listen to testimony during a hearing in Washington on Jan. 21, 2015. (Susan Walsh/AP Photo)

House and Senate Health Committee Leaders announced that they would push forward bipartisan legislation that seeks to end surprise medical bills and lower prescription drug and other medical costs by requiring greater transparency from medical professionals.

“Surprise medical bills are the outrageous result of a broken system that takes advantage of vulnerable patients. Last summer, our two committees advanced bipartisan solutions to protect patients from these bills, and in December we announced a bipartisan, bicameral agreement to put an end to this egregious billing practice,” House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-N.J.), Ranking Member Greg Walden (R-Ore.), Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) said in a statement Feb. 7.

In December 2019, the House Energy and Commerce and Senate Health Committee leaders first announced a bipartisan, bicameral agreement (“Lower Health Care Costs Act of 2019”) that would protect consumers’ medical rights and end opaque billing practices.

The committee leaders broadened an investigation into surprise billing practices of doctors’ staffing companies and leading insurers. In letters to top insurance companies, the congressmen requested “information and documents pertaining to the billing policies and practices of physician staffing companies and insurers when a patient receives care from an out-of-network provider at an in-network facility, which too often results in a surprise medical bill.”

Investigations by the American Enterprise Institute and the Brookings Institution were referenced in those letters, showing that surprise bills are frequently associated with services provided by an out-of-network emergency physician or supplementary clinician—“such as a radiologist, anesthesiologist, pathologist, hospitalist, or assistant consulting surgeon—at an in-network health facility.”

Many of the services that are frequently related to surprise bills are areas where hospitals have outsourced patient care.

The lawmakers pushed the companies for answers “as to the policies and practices when a provider is not in-network with a patient’s insurance company, including the policies as they relate to sending surprise bills, and the relationship with certain private equity firms.”

One of the main goals of the bill is to protect patients and their families from the devastating financial toll a surprise medical bill can have.

Alexander said in December: “The legislation would end surprise billing of patients by creating a new system of dispute resolution that includes arbitration, provide nearly $20 billion for five years of funding for the nation’s 1,400 community health centers, and lower the cost of prescription drugs and other medical services by requiring transparency and competition. Congress should pass the bill promptly and give the American people a very good Christmas present.”

“Americans who follow the rules and pay their premiums shouldn’t get stuck with a $50,000 bill because a hospital contracted a NICU to an out-of-network provider, or a $109,000 bill after being rushed to a nearby hospital for a heart attack,” Walden said. “To put it plainly: Americans are sick and tired of being ripped off by surprise medical bills, and they want Congress to act.”

The “Lower Health Care Costs Act of 2019” (pdf) received 20-3 committee votes that included two votes against it—by Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.)—that were cast by proxy.