Competing factions within Congress are lobbying the Biden administration as it preps regulations that need to be issued by July 1 detailing how the arbitration process will work as part of a law aimed at preventing individuals from receiving surprise medical bills, according to a published report.
One group of bipartisan members of Congress are asking the Biden administration to lean more toward protecting insurers while the other wants to make sure that consumers are protected at the expense of providers and insurance companies.
The issue of surprise medical billing has front-and-center among the healthcare debate in the United States for several years now. In many cases, usually in emergency situations, individuals are treated at facilities they think are part of their insurance networks, only to find out later that certain doctors were not part of the network. That leads to patients receiving bills from doctors or facilities that can get as high as hundreds of thousands of dollars.
Last December, Congress came together to pass the “No Surprises Act” which prohibits hospitals and healthcare providers from charging fees that a patient’s insurance will not cover and prevents patients from being billed when they receive emergency services from a provider that is not part of their network.
The problem is that providers and insurance companies can bring any discrepancy in the reimbursement amount to an arbitrator. Interested parties are now seeking to make sure that the Biden administration leans their way when rolling out the details on how the arbitration process will work.
“We have significant concerns … that expanded arbitration considerations could place undue harm and financial burdens on consumers,” one group wrote in its letter. “Failure to adequately address these potential regulatory loopholes would allow private equity firms and out-of-network providers to maintain a lucrative and inflationary business model designed to maximize profits at the expense of American families.”
