The Solution

Everyone in America deserves affordable, high-quality coverage and care, and control over their health care choices. Surprise medical bills undermine these values, putting the health and financial stability of millions of patients at risk every year. As organizations representing America’s employers, unions and health insurance providers, we all have a role to play in ensuring that patients are informed, engaged, and protected from excessive costs. While the passage of the No Surprises Act was a first step towards safeguarding patients from surprise medical billings, maintaining these protections is even more important so that consumers and families see the full benefits of the law.

Those key protections include:

  • New billing protections for emergency care and non-emergency care from out-of-network providers at in-network hospitals.

  • Requirements for providers and care facilities to share easy-to-understand notices ahead of any provided care or treatment plan around estimated costs. Providers are required to notify patients if any care would be provided on an out-of-network basis and options for in-network care if preferred. 
  • Provisions that support affordable, in-network care and protect from abuse and misuse of a costly arbitration process that can add additional costs to consumers’ premiums. This includes relying on the qualified payment amount (QPA) as the primary consideration for final payment determinations during the independent dispute resolution process.

  • Leading policy experts have made clear that achieving long-term savings intended by the No Surprises Act is only possibly by anchoring a final out-of-network payment determination to the QPA. This will have the added benefit of reinforcing a predictable and limited arbitration process, and ultimately, the goal of improved access to affordable, in-network care.

    To view the Coalition’s principles, click here.