No Surprises Act

Posted on December 7, 2019

One in five visits to the emergency room result in the patient receiving a surprise medical bill. Surprise medical bills happen when a patient sees a doctor that they did not choose: either because of emergency care at an out-of-network hospital, or because an out-of-network doctor, not chosen by the patient, treats them.

The No Surprises Act will ensure that patients do not receive a surprise bill. Patients would only be required to pay the in-network amount – whether they receive out-of-network emergency care or non-emergency care at in-network facilities and are treated by out-of-network providers without their knowledge. 

The Solution

Commercial, Median, In-network Price – by service, by geographical region — For surprise bills, insurance companies would pay medical and air ambulance providers the local median contracted commercial amount that the doctors and hospitals negotiated with insurers and agreed upon as of January 31, 2019, and inflated annually by the Consumer Price Index All Urban Consumers (CPI-U) in that geographic area.

Baseball-Style Arbitration

Similar to New York, for commercial, median, in-network payments that exceed $750, providers, hospitals, and plans will have the option to enter into binding, baseball-style arbitration.

The non-partisan Congressional Budget Office estimates this approach will save taxpayers $22 billion over ten years.