Lessons Learned from the States: Surprise Billing Reforms & The Impact on Consumers’ Costs

Sep 30, 2021 | Arbitration, Blog Post

Starting in 2022, patients across the country will no longer face the threat or fear of a surprise medical bill, but policy experts, consumer advocates, health insurance providers and employer representatives urged the Biden Administration to protect Americans from the unexpected costs that can come from a bureaucratic, costly arbitration model.

As part of a virtual briefing hosted by the Coalition Against Surprise Medical Billing, leading voices from across the health system shared their perspective and experience about the impact of arbitration from early state experiences with surprise billing reforms, and ultimately, the intent of the No Surprises Act in safeguarding against inflationary costs from out-of-network providers and private equity firms.

Highlights from the discussion are included below:

  • “This bill was set up to protect consumers. It is so important for the IDR process not to be organized in a way that would allow consumers to get hurt on the back end through higher costs or higher premiums.” – Kevin Lucia, Founder and Co-Director, Center on Health Insurance Reforms at Georgetown University
  • “If we don’t get arbitration right, we will see all costs packed into premiums and costs continuing to spiral out of control. How do we deal with rates when they are not negotiated is one of the most important pieces to solve for and it has to be based on a negotiated rate or we run the risk of seeing the abuses we have seen in other states.” – Frederick Isasi, JD, MPH, Executive Director, FamiliesUSA
  • “One of the parts of the law is affordability and cost containment. I think we have missed the mark in New Jersey for cost-containment because of the way the dispute resolution process has evolved.” – Wardell Sanders, President, New Jersey Association of Health Plans
  • “We do not want to incentivize providers to get out of the network. Any decision that’s made that pushes reimbursement higher for out-of-network providers is a lose-lose decision.” – Marta Green, Health Plan Research and Administration Chief, CalPERS
  • “There should be no room in any of these processes for gamesmanship. It is important that the process is predictable, stable, and that we have the ability to shield consumers from costs long-term.” – Katie Berge, Director of Federal Affairs, Leukemia and Lymphoma Society

To view the impact of arbitration in key states, click here. To learn more about how the Biden Administration can protect patients from abuse of arbitration, click here.