Kind, Grothman urge revision of surprise medical billing rule

November 17, 2021 10:28 AM | Maggie Gruennert (Administrator)

Wisconsin Health News
November 17, 2021

U.S. Reps. Ron Kind, D-La Crosse, and Glenn Grothman, R- Glenbeulah, recently joined 150 other lawmakers in urging the federal government to revise the interpretation of its surprise billing rule.

In a letter sent to Department of Health and Human Services Secretary Xavier Becerra, U.S. Department of Labor Secretary Martin Walsh and Department of the Treasury Secretary Janet Yellen, the lawmakers said the administration’s interpretation does not “reflect congressional intent” when the No Surprises Act passed Congress in December 2020. 

Specifically at issue is the administration’s use of the median in-network rate as the primary determining factor in payment disputes between providers and payers during the independent dispute resolution process established in the law.

"This approach is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care – the exact opposite of the goal of the law,” they said in the letter. “It could also have a broad impact on reimbursement for in-network services, which could exacerbate existing health disparities and patient access issues in rural and urban underserved communities.”

The law, effective Jan. 1, states that patients are held harmless and will not be responsible for medical bills higher than what they would pay an in-network provider. If providers or insurers believe an out-of-network medical bill or payment is unreasonable, either party may initiate the independent dispute resolution process