The AHA today submitted comments on the revised version of the Lower Health Care Costs Act (S. 1895), legislation to prevent surprise medical bills, reduce prescription drug prices, improve transparency in health care, invest in public health and improve health information exchange. The bill holds patients harmless from surprise medical bills and, in an update from the draft legislation, uses a benchmark rate to resolve payment disputes between plans and out-of-network providers.
 
“We support the Committee’s efforts to find a federal solution to surprise medical bills that truly protects the patient,” AHA said in a letter to members of the Senate Health, Education, Labor and Pensions Committee. “We believe that the solution is simple: protect the patient from surprise medical bills for emergency services, or for services obtained in any in-network facility when the patient could reasonably have assumed that the providers caring for them were in-network with their health plan, and limit the patient’s cost-sharing to an in-network amount. Once the patient is protected, hospitals, providers and plans should be allowed to negotiate fair and appropriate reimbursement without additional statutory interference. Further government involvement is not necessary and this approach would avoid potential widespread, unintended negative consequences.”
 
AHA strongly urged the committee to eliminate the provision that would institute a median in-network rate for out-of-network payments. “Setting a rate in statute gives insurers few incentives to develop robust networks with hospitals and physicians,” and paying for emergency care at the median in-network rate “would surely underpay for these services and create an incentive for insurers to avoid paying fair reimbursement for these services,” the association said. “This approach is an obvious windfall for the insurance industry without any assurance that health plans will pass these savings on to consumers through lower premiums.”

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