Senator Murray Announces Bipartisan Deal to Protect Patients, End Surprise Medical Bills

New bipartisan legislation would build on strong state laws like Washington state’s to expand protections and end surprise medical bills for all patients, without increasing premiums

Murray on the need to swiftly pass surprise billing legislation: “Getting this done is especially important right now, because we have seen during this pandemic just how devastating it is for patients to get a surprise bill they didn’t expect and can’t afford, for lifesaving care they thought was covered.”

Savings from proposal would allow Congress to fund community health centers and other critical primary care programs for four years 

(Washington, D.C.) — Today, U.S. Senator Patty Murray (D-WA), top Democrat on the Senate health committee, released the following statement regarding a bipartisan deal she brokered with her colleagues in the House and Senate on legislation to end surprise medical bills. Senator Murray has been working to end surprise billing, and raised the issue at one of the first in a series of HELP Committee hearings on lowering health care costs back in 2018.

“I’ve heard from so many patients who have gotten exorbitant surprise bills for out-of-network medical care—even when they made sure to go to an in-network facility. Today I’m thrilled to be able to tell them that we have reached a bipartisan agreement that will end the practice of surprise billing once and for all. As with any compromise, this isn’t the bill I would have written on my own—but I’m pleased to say that it meets all of the principles I have been focused on from the start. It protects patients from surprise medical bills, without increasing their premiums or interfering with strong state-level solutions to this problem—like Washington state’s. In fact, it builds on and expands the ban on surprise medical bills to more people in our state.

“I’m going to be doing everything I can to make sure we go from an agreement to legislation that is passed and signed into law as soon as possible. Getting this done is especially important right now, because we have seen during this pandemic just how devastating it is for patients to get a surprise bill they didn’t expect and can’t afford, for lifesaving care they thought was covered. This pandemic is scary enough for families without them having to fear that the care they need may come with a price tag they can’t afford. The savings from this agreement will also allow us to provide four years of funding for community health centers and other critical primary care programs. These programs support providers on the frontlines of so many public health crises, like the maternal mortality crisis, the mental health crisis, and of course this pandemic—and they absolutely need our support.”

In a joint statement today, Senator Murray and her colleagues announced the details of the deal and said they would push to get it included in the end of year funding package.

The bipartisan, bicameral agreement protects patients and establishes a fair payment dispute resolution process including:

• Holds patients harmless from surprise medical bills, including from air ambulance providers, by ensuring they are only responsible for their in-network cost-sharing amounts, including deductibles, in both emergency situations and certain non-emergency situations where patients do not have the ability to choose an in-network provider.

• Prohibits certain out-of-network providers from balance billing patients unless the provider gives the patient notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services and the patient provides consent to receive out-of-network care.

• Creates a framework that takes patients out of the middle, and allows health care providers and insurers to resolve payment disputes without involving the patient. 

• Under the agreement, insurers will make a payment to the provider that is determined either through negotiation between the parties or an independent dispute resolution (IDR) process. There is no minimum payment threshold to enter IDR, and claims may be batched together to ease administrative burdens.

• If the parties choose to utilize the IDR process, both parties would each submit an offer to the independent arbiter. When choosing between the two offers the arbiter is required to consider the median in-network rate, information related to the training and experience of the provider, the market share of the parties, previous contracting history between the parties, complexity of the services provided, and any other information submitted by the parties. 

• Following an IDR process, the party that initiated the dispute may not take the same party to arbitration for the same item or service for 90-days following a determination by the arbitrator. However, all claims that occur during the 90-day period are eligible for IDR after the 90-days. 

• Provides additional consumer protections when insurance companies change networks, including a transition of care for people with complex care needs and appeal rights for consumers. 

• Empowers consumers by providing a true and honest cost estimate that describes which providers will deliver their treatment, the cost of services, and provider network status.

The legislation would also provide around $18 billion in savings—which would allow Congress to provide four years of funding for community health centers and other critical primary care programs, including the National Health Service Corps, the Teaching Health Center Graduate Medical Education Program, the Special Diabetes Program, and the Special Diabetes Program for Indians.

Legislative text is available HERE. 

Section-by-section is available HERE.

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