COVID Relief Bill Includes Surprise Medical Billing Fix

While the health care industry agreed that patients should be held harmless in emergency situations, hospital and physician groups and insurers fought vigorously over who would pick up the tab.

The compromise deal that congressional committees struck earlier this month was considered largely a win for hospitals and doctors, and tweaks made in the final legislation are even friendlier to providers.

The previously announced deal called for health insurers and providers to negotiate most billing disputes or bring their complaints to a mediator.

Major Shift

But in one key change, the final version of the bill would forbid arbiters from taking into account Medicare and Medicaid rates, which typically are much lower than what commercial coverage pays. (Trump is expected to sign the bill later this week.)

That is a loss for insurers, employers who fund a major chunk of private coverage, and patient advocates who thought including those public rates as a barometer could help curb health-care prices.

As a guardrail, the measure also bars arbiters from considering providers’ billed charges, which usually are well out of line with what insurers or patients end up paying.

However, in a win for health insurers, lawmakers appear to have watered down a measure that would have required them to disclose detailed information to employers about their drug costs and rebates through their contracts with pharmacy benefit managers, whose business practices have come under scrutiny in recent years for their role in high drug costs.

Instead, the legislation calls for insurers to submit more general information on medical costs and prescription drug spending to relevant federal agencies, which would feed into a government report on drug pricing trends.

“It remains to be seen how well the arbitration system will work,” Buckey said, “but this is an important step in the right direction for protecting consumers, including those who did all the right things to ensure their care was in-network but received surprise and balance bills through no fault of their own.”

Read more: 

• Which health care specialties send the most surprise bills?
• Two surprise billing proposals vie for support
• The cost of out-of-network bills? $40 billion annually