Coalition Members Call for Fair and Reasonable Payment Benchmark for Out-of-Network Care

Washington, D.C. – Addressing the crisis of surprise medical bills that burden American families is a top priority for a growing number of bipartisan members of Congress as well as the Trump Administration. As Washington considers policy changes to address surprise medical billing, the Coalition Against Surprise Medical Billing – a partnership among leading groups representing employers, unions and health plans – launched a national advocacy campaign to advance common-sense reforms that would protect patients from exorbitant medical charges from out-of-network providers.

Millions of Americans receive surprise medical bills every year at prices they cannot afford. Surprise medical billing, or “balance billing” of out-of-network medical care, is one of the most pressing health and affordability challenges facing patients and their families. These surprise medical bills often include exorbitant charges that are far greater than in-network rates and can cost consumers thousands or even tens of thousands of dollars. According to a recent Kaiser Family Foundation poll, more than four in ten (41 percent) of insured adults ages 18-64 said they received a surprise bill in the last two years.

The diverse Coalition, which includes America’s Health Insurance Plans, American Benefits Council, Blue Cross Blue Shield Association, ERISA Industry Committee, HR Policy Association, National Association of Health Underwriters and National Retail Federation, serves tens of millions of Americans and employees who are impacted by surprise medical bills.

While much attention has been paid to protecting patients from the “surprise” of these high charges, the Coalition is calling for federal legislation that would provide new patient safeguards related to emergency care while also implementing a fair and reasonable payment benchmark for providers as an alternative to costly arbitration proposals. Recent estimates from the non-partisan Congressional Budget Office (CBO) show that consumers and taxpayers could save more than $25 billion over ten years if Congress were to implement a fair and reasonable federal benchmark for out-of-network provider rates as part of comprehensive reforms.

Most doctors work hand-in-hand with hospitals and insurance providers to ensure American families receive quality, affordable care. Since the majority of surprise medical bills come from a small subset of providers – the clinical specialists and hospitals who choose not to participate in-network – establishing a federal benchmark would ensure that patients who are treated by these out-of-network providers still benefit from negotiated rates.

By establishing patient safeguards for emergency care and the federal benchmark for rates, doctors and health insurance providers avoid the costly, bureaucratic arbitration processes that drive up premiums and increase costs for taxpayers and employers.

Over the next several weeks, the Coalition will release new ads in Washington, D.C. and across national social platforms to reinforce the need for meaningful consumer protections that have a track-record of stopping abuse and closing loopholes in the current health system – and avoiding the flawed policy reforms, like arbitration, that will incentivize price-gouging in the future. To view the Coalition’s policy solutions, click here.

For more information and updates on the Coalition, click here.