Tenn. Sen. Lamar Alexander says he’s arrived at a compromise on surprise medical billing. The proposed restrictions have been politically popular, but the details have been difficult to work out, as many parts of the health care industry have actively worked against the legislation.
Companies that staff emergency rooms have been the most vocal. The largest are TeamHealth and Envision, both based in Tennessee. They’ve lobbied against Alexander’s proposal, even though they say they’re ready to end surprise billing, which occurs when patients get an out-of-network bill for services at a hospital that’s within their insurance network.
Staffing firms like the idea of disputes going to a third party, and they want to see that provision expanded in the legislation from Alexander, who chairs the Senate’s health committee. Currently, the outside review would happen only with bills over $750.
“The $750 minimum threshold to access [independent dispute resolution] would make the overwhelming majority of emergency medical claims ineligible and would promote egregious underpayments by insurers as they would be incented to keep payments below the threshold,” TeamHealth said in a statement to WPLN.
Envision also says insurers would have an upper hand.
“While this proposal is an improvement, it continues to use a benchmark that would not apply to the majority of facility-based providers,” the company said in a statement. “Without an arbitration mechanism that applies to a reasonable number of claims, the concerns raised by the provider community will persist.”
The surprise medical bill legislation hasn’t been set for a vote of the full Senate or House, but it is bipartisan and bicameral. The compromise was reached with House Energy and Commerce Committee Chairman Frank Pallone, D-N.J.
“I do not think it is possible to write a bill that has broader agreement than this among Senate and House Democrats and Republicans on Americans’ number one financial concern: what they pay out of their own pockets for health care,” Alexander said in a statement. “Congress should pass this bill promptly and give the American people a very good Christmas present.”