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It would prevent providers from charging exorbitant fees for medical procedures, and could even lead to lower private insurance premiums. That could prompt more physicians to move out of insurer networks, decreasing access to care for patients, Bucshon said.īut a set rate for doctors and other health care providers could be beneficial in the long run, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. The proposed arbitration process could lead insurers to lower their median in-network rate, which would pressure health care providers into accepting lower payments for their services. Bucshon said this implies the median rate is always correct, when other factors, such as the severity of a patient’s illness and the amount of attention they need from medical professionals, should equally be taken into consideration during negotiations. The interim rule says the correct fee for a disputed medical bill is the median in-network rate paid by an insurer for the medical procedure. The problem comes from the proposed starting point in the arbitration process.
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Then an arbitrator chooses one in a decision that’s binding. If they can’t, a federal independent dispute resolution process begins and the matter goes to an arbitrator.īoth sides submit a payment amount with supporting documentation. Murray and Pallone sent a letter last month to Biden administration officials backing the arbitration process.Īccording to the rule, whenever there is a dispute over the cost of a medical procedure, health care providers and insurers have 30 days to agree to a new amount. She and Representative Frank Pallone, a New Jersey Democrat and chair of the House Energy and Commerce Committee, were key players in getting the No Surprises Act included in a COVID relief bill last December that was signed by President Trump. The arbitration process “strikes the right balance among competing stakeholder requests for consideration of higher and lower payment rates,” said Senator Patty Murray, a Democrat from Washington who chairs the Senate Health Education, Labor and Pensions Committee. Lawmakers who supported the legislation also split along the same lines. Nearly two-thirds of the public worry about affording surprise medical bills, according to a February 2020 Kaiser Family Foundation poll.īut as soon as the Biden administration released the interim rule, which is open to public comment until the end of November, two sides took shape- health care providers worried insurers would have a leg up during negotiations, and insurers who praised the administration for taking the right approach. When a health care provider and insurer disagree with the reimbursement for a procedure or service, the interim rule requires them to settle the dispute through arbitration, protecting patients from time-consuming negotiations and expensive fees. The law is designed to prevent unexpectedly large medical bills from being passed along to patients who had expected their insurance would cover most of the cost. Bucshon, who is a doctor, helped organize a bipartisan letter earlier in November signed by more than 100 House members to administration officials urging them to revise the rule. “It’s not even close to being what Congress passed into law,” he said of the rule.