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DHA on Surprise Billing: Take Patients out of the Middle, but Reject Rate Setting


Congress and the Administration are focused on addressing “surprise” medical bills. Today, the House Energy and Commerce Committee is marking up legislation on the issue and your Delaware Healthcare Association (DHA) is weighing in on the debate. DHA is advocating for policies that don’t leave the patient holding the bag, or in this case, stuck with an expensive and unexpected medical bill, while also preserving the ability of providers and payers to negotiate rates. This is the way to protect patients in the short term - by eliminating surprise medical bills -as well as the long term - by ensuring our health system receives the funds needed to continue to provide broad, high-quality access to medical care for Delawareans. 

No one likes to receive an unexpected medical bill for care from a provider that was out-of-network, or for services not covered by their health insurance. Several proposals have been introduced in Congress to address surprise medical bills, and today, the House Energy and Commerce Subcommittee on Health will debate H.R. 3630, the “No Surprises Act,” aimed at prohibiting balance billing and surprise billing. Unfortunately, the bill also establishes a payment benchmark – at minimum, the median contracted rate – to resolve out-of-network payment disputes between providers and insurers. 

DHA sent a letter to U.S. Congresswoman Lisa Blunt Rochester (D-DE), a member of the Health Subcommittee, raising concerns with the proposal to artificially set reimbursement rates in out-of-network billing instances. Such proposals would unbalance market negotiations between providers and payers, with negative implications for providers and the patients we serve. Instead, DHA calls on Congress to require payers and providers to negotiate out of network billing and reimbursement structures that relieve the patient from getting surprise out of network bills for procedures where time constraints or provider sourcing do not allow for real provider choice by the patient. DHA also strongly favors the inclusion of an opt-out for states who implement their own arbitration regimes to address instances of surprise billings. 

DHA will continue to monitor this and other surprise billing proposals, such as S. 1531 endorsed by U.S. Senators Tom Carper (D-DE) and Chris Coons (D-DE), and advocate for solutions that will protect patients while preserving the ability of providers and payers to negotiate rates. 

To read DHA’s letter, please click here.