Dear Chairman Pallone and Ranking Member Walden:
The undersigned organizations believe a fair and equitable independent dispute resolution (IDR) process is
an essential component of any surprise billing solution and should be included in any final bill coming out of
the House Energy and Commerce Committee to ensure the legislation is balanced and does not result either
in unfair payments to physicians or unreasonable bills to health plans. We fully support the central goal of
the No Surprises Act to protect patients from surprise medical bills when they unknowingly receive services
from out-of-network providers in in-network facilities. We also support the provisions in the No Surprises
Act that would ensure patients are only responsible for in-network cost-sharing in these situations, and that
their cost-sharing count toward in-network deductibles and out-of-pocket maximums. We also agree that
patients should be taken out of any payment disputes between physicians and insurers that arise from these
situations.
However, once the patient is protected from surprise medical bills, it is equally important to ensure that the
legislation does not create new imbalances in the private health care marketplace by undermining the ability
of doctors to secure fair reimbursement for their services. The health insurance marketplace is already
heavily consolidated. Instituting a federal government rate-setting scheme that allows private insurers to
force discounted rates on physicians, hospitals and other health care providers based on their median 2019
in-network rates puts both network and non-network providers at a disadvantage and will result in sudden
drops in reimbursement for emergency and nonemergency hospital-based care. This will create patient
access problems, particularly in rural areas and other underserved populations that are already experiencing
health care provider shortages. In fact, the California Department of Managed Health Care reports consumer
access to care complaints have increased 48% since California passed its surprise billing law. There are also
preliminary reports that California insurers are seeking to drive down in-network median payments by
dropping providers from their network who are currently paid above the median.
Read full letter here
