Legislation introduced in Congress.

The American College of Emergency Physicians applauds the release today of the framework for the Protecting People from Surprise Medical Bills Act. ACEP strongly supports the proposal as outlined because it truly takes patients out of the middle of disputes between insurers and medical providers and implements a market-based approach to encourage these parties to set fair payments and prices from the start.

Dr. Vidor Friedman, president of ACEP, said, “ACEP is pleased that Representatives Ruiz, Roe, Bera, Morelle, Taylor, Bucshon, Shalala, and Wenstrup recognize the need for a policy remedy that more directly addresses the root cause of surprise bills – inadequate insurance networks. Patients need a legislative solution to protect them when they have surprise gaps in their expected insurance coverage, and this proposal takes critical steps to do so by encouraging more transparency from insurance companies and making sure that patients can better understand the limitations of their insurance.

“The proposed approach makes certain that a patient only pays the in-network amount for emergency care, whether the care delivered was in- or out-of-network. ACEP strongly supports the proposal’s provision that extends this important protection to the patient’s deductible – bringing down the amount a patient must pay out of their own pocket before their insurance kicks in. This key provision will encourage health plans to expand their networks for emergency care; addressing the root cause of “surprise bills,” narrow insurance networks.

“In addition, this proposal calls for ‘baseball-style’ arbitration to ensure a fast and fair resolution of any billing issues between insurers and providers. This simple, efficient, and proven process has effectively incentivized providers to charge reasonable rates and insurers to pay appropriate amounts in several states. In New York, this arbitration model has curbed the number of surprise bills without raising costs.

“With the introduction of this proposal, ACEP is optimistic a solution is in sight that will allow Congress to protect patients from surprise bills while avoiding unintended cost consequences or massive disruption of our health system. We look forward to working with bipartisan members of the House and Senate on measures that hold patients harmless, provide a level playing field for providers in network or in billing negotiations with insurers, and continue to enable emergency physicians to treat anyone, anytime, anywhere, regardless of their insurance status or ability to pay.”