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Surprise Billing Must be Stopped Correctly 


By Wayne Smith, President & CEO, Delaware Healthcare Association

Congress’ objective for surprise billing legislation ought to be twofold:  First, protect the patient so they don’t get a surprise bill. Second, don’t threaten access to care by interfering with direct and unfettered negotiations between providers and payers to resolve out of network billing cases.

Unfortunately, a reported “deal” struck by some congressional leaders falls short of that goal and must be rejected. 

This week, it was announced that the Chairs of the U.S. House Energy and Commerce Committee and the Senate Health Committee reached a deal on surprise billing legislation that they intend to attach to an end of year funding bill. As reported, the major components of that agreement would threaten network adequacy. This would threaten access to care, particularly in the more rural and underserved areas of our state.

Those problematic components include rate setting, or the use of a benchmark rate to determine payment. An arbitrary rate gives insurers an incentive to remove hospitals from their networks and force artificially low reimbursement rates. Hospitals will close in such an environment, imperiling access to care. Moreover, such proposals would provide a huge windfall to commercial insurance companies at the expense of the nation's community hospitals.

DHA sent letters to Delaware’s congressional delegation, U.S. Senators Tom Carper, Chris Coons and U.S. Rep. Lisa Blunt Rochester (D-DE) December 9th, urging them to reject any proposal that contains rate setting, as the resulting harm in network adequacy will threaten access to care for many Delawareans.

DHA is urging lawmakers to arrive at a solution that protects patients from surprise bills while allowing payers and providers to negotiate payments for out of network cases. Current Delaware law regarding patients who visit the Emergency Department has done exactly that for almost two decades and works very well. For more on DHA’s position on surprise billing, please click here to read our Surprise Billing principles.