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December 20, 2019

Discussion Over Surprise Billing Continues

Several key members of Congress have reached an agreement on surprise billing. The proposal offers ideas on how to discourage frivolous disputes between providers and payers. The managed care industry remains opposed to any arbitration clauses related to levels of payment related to out of network and balance billing amounts. The industry believes that out of network bills - except in true emergencies - are a matter of contract between the payor and the member. Additionally, the mechanics of how to determine the amount to be paid is cumbersome and expensive, and the scheme may incentivize providers to remain out of network. The Senate is expected to address the surprise billing issue by the end of this year.