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Taking the Surprise Out of Surprise Billing

Few people like surprise medical bills. That’s why there’s an active movement to protect consumers from the financial burdens created by surprise medical bills while addressing the concerns of providers and insurers.

A surprise medical bill occurs when someone who has insurance inadvertently receives care from an out-of-network provider and is charged a higher than expected rate.

Here are the three primary pieces of legislation being considered:

• The Consumer Protections Against Surprise Medical Bills Act of 2020 (HR 5826) passed out of the Ways and Means Committee and awaits floor action in the House.

• The Ban Surprise Billing Act (HR 5800) passed out of the Education and Labor Committee and awaits floor action in the House.

• A compromise was reached on two bills — S. 1895, approved by the Senate Committee on Health, Education, Labor, and Pensions, and H.R. 2328, approved by the House Energy Committee.

While the proposals are very similar to each other, the biggest differences are how payments to out-of-network providers are determined and whether to include ambulance services.

In addition, 28 states have already enacted consumer protections to address surprise medical bills, though the state laws cannot help people covered by their employer’s self-funded plans or people who receive surprise bills because of air ambulance services.

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