Washington seemed to be working, for once. Last month, key members of the House and Senate — House Energy and Commerce Committee Chairman Frank Pallone Jr., D-N.J., Rep. Greg Walden, R-Ore., Senate Health Committee Chairman Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash. — had negotiated legislation that would end so-called surprise medical billing. Example: when you have emergency surgery, then get slammed unexpectedly with a huge bill from an out-of-network anesthesiologist you didn’t choose. The legislation was set to be included last month in a must-pass funding bill. Then the leaders of the House Ways and Means Committee introduced at the last minute a competing bill, and the resulting legislative turf war stalled the momentum. Now, no solution may pass anytime soon.
Neither the first bill nor the second, introduced by Ways and Means Committee Chairman Richard Neal, D-Mass., and Ranking Republican Kevin Brady of Texas, is perfect. But they would help, and in similar ways. A deal should have been struck weeks ago.
The issue revolves around ancillary providers — that is, doctors and other specialists who contract with, but are not employees of, medical facilities such as hospitals. Even if their hospitals accept standard health insurance, causing patients to believe all their services will be covered, these ancillary providers might not be included. Instead, they charge sometimes exorbitant out-of-network rates directly to patients who had expected their health plans to pick up the tab.
The two groups of legislators agree that when patients go to in-network medical facilities, they should pay no more than in-network prices to anesthesiologists and other ancillary providers, letting their insurance companies sort out the rest. But they disagree on how to determine the amount insurance companies would end up paying ancillary providers for their services.
The Pallone-Walden-Alexander-Murray bill would use regional averages to set rates, which would end the practice of charging unusually high prices for ancillary medical services. The Neal-Brady bill would create an arbitration process that would settle payment rates when there are disputes between insurers and doctors, basing its rulings on “payments made to similar providers for similar services in similar areas.” If it works well, arbitration would presumably result in mostly similar outcomes to direct rate-setting. If it does not, it could give doctors an opportunity to game the process.
In truth, neither option is ideal. The best way to end surprise billing is simply to require that all ancillary providers working at in-network facilities are themselves also in-network. That would avoid any controversy about government rate-setting, encouraging insurance companies and providers to instead negotiate down prices.
But the Pallone-Walden-Alexander-Murray bill was a decent second-best plan — one that is pretty close to what Neal and Brady themselves proposed. Since they lost the chance to pass surprise billing legislation last year, lawmakers must settle their differences as soon as possible. The gap between them is bridgeable.