Commenting on the rate-setting provision of the House Energy and Commerce Committee’s legislative proposal to address surprise medical bills, the AHA, America’s Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association, and Federation of American Hospitals said they oppose establishing a benchmark payment to resolve out-of-network payment disputes between providers and insurers and asked that the committee instead consider an independent dispute resolution process.
“We are concerned that the rate-setting provision of the [draft No Surprises Act] legislation is a plan-determined, non-transparent process that will upend private payment negotiation,” the groups said yesterday in a joint letter to committee leaders. “A default rate will become the payment ceiling and remove incentives for insurers to develop comprehensive networks, as there are already increasing numbers of narrow network products offered that exclude certain types of providers.”
The hospital groups said the committee “should instead consider the establishment of a dispute resolution process, such as arbitration or mediation, as a way to resolve payment issues. Such a process could serve as a backstop after a period of direct negotiation between payers and providers and could, as evidenced by the experience in New York State, both reduce the incidence of out-of-network billing and incentivize network participation.”
In February, the groups shared with Congress their principles for evaluating legislative proposals to address surprise medical bills.

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