WHA Cautions Congress Against Wrong Surprise Billing Fix

December 12, 2019

WHA’s board officers along with its Transparency Task Force Chair sent a letter to Wisconsin’s Congressional delegation asking them to oppose attaching the wrong surprise billing fix to any end-of-year spending package.

Education, Labor, and Pensions Committees recently announced an apparent “deal” to move forward on surprise billing legislation, the letter requested they remove two provisions that are unnecessary and would harm patients and providers. Most controversial is the proposal that providers accept a government-set benchmark payment (an undefined, local median in-network rate) for any potential surprise bills under $750. As the Congressional Budget Office has confirmed, this proposal would essentially create a fee schedule for services under that threshold in the commercial sector, while also moving more providers out of network.

Additionally, WHA’s leaders requested Congress also remove a contracting mandate that would make providers unable to prevent health insurers from cherry-picking services or providers under contract terms. While insurers have billed these practices as anti-competitive, in reality this mandate would tip the scales in favor of the insurance industry and could threaten the viability of some providers, particularly in rural areas. It could also lead to patients driving longer distances to seek care by making it easier for insurers to steer patients to certain providers.

WHA also sent out a HEAT alert urging WHA members to contact their federal lawmakers warning against these two harmful provisions. Congress needs to pass a spending bill to fund the government by Dec. 20, and some Congressional leaders have been pushing to attach a surprise billing package to that spending plan.

On Dec. 11, the House Ways and Means Committee also announced they were working on a surprise billing package that would focus more on arbitration – an approach WHA and provider groups have supported. While details have not yet been released, the lack of agreement on this issue will likely make it harder for Congress to pass something on surprise billing before year’s end.

WHA will continue to closely monitor this issue and advocate for a solution that protects patients without harmful consequences for Wisconsin’s health care system.

This story originally appeared in the December 12, 2019 edition of WHA Newsletter