Legis Daily

Protecting Patients from Surprise Medical Bills Act

USA116th CongressHR-4223| House 
| Updated: 9/10/2019
Ross Spano

Ross Spano

Republican Representative

Florida

Education and Workforce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Protecting Patients from Surprise Medical Bills Act This bill prohibits balance billing the holder of a self-insured group health plan (plans in which an employer pays claims to providers for health benefits offered to employees) for emergency and specified nonemergency services. Balance billing is the practice of charging a plan holder for the difference between a provider's rate for a service and the in-network rate. First, the bill requires self-insured group health plans that cover emergency services to comply with the requirements for other types of group health plans. This includes the requirement to bill a plan holder no more than the in-network cost-sharing amount for covered emergency services, even if the provider is out-of-network. Second, the bill prohibits emergency services providers from billing a self-insured group plan holder for any remaining balance for covered services not paid to the provider by the employer. Further, unless a plan holder has the option to select an in-network provider, an out-of-network provider of covered, nonemergency services is prohibited from billing plan holders for the difference in rates for such services when provided at an in-network facility. Employers must pay out-of-network providers for services subject to the requirements of this bill (1) the amount the provider claims, (2) the usual and customary amount for such services in that community, or (3) an amount agreed to within 60 days of when the claim is submitted. Otherwise the parties may enter voluntary binding arbitration.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
May 1, 2019

Latest Companion Bill Action

S 116-1266
Introduced in Senate
Aug 30, 2019
Introduced in House
Aug 30, 2019
Referred to the House Committee on Education and Labor.
Sep 10, 2019
Sponsor introductory remarks on measure. (CR H7587-7588)
  • May 1, 2019

    Latest Companion Bill Action

    S 116-1266
    Introduced in Senate


  • August 30, 2019
    Introduced in House


  • August 30, 2019
    Referred to the House Committee on Education and Labor.


  • September 10, 2019
    Sponsor introductory remarks on measure. (CR H7587-7588)

Health

Related Bills

  • S 116-1266: Protecting Patients from Surprise Medical Bills Act
Alternative dispute resolution, mediation, arbitrationEmergency medical services and trauma careHealth care costs and insurance

Protecting Patients from Surprise Medical Bills Act

USA116th CongressHR-4223| House 
| Updated: 9/10/2019
Protecting Patients from Surprise Medical Bills Act This bill prohibits balance billing the holder of a self-insured group health plan (plans in which an employer pays claims to providers for health benefits offered to employees) for emergency and specified nonemergency services. Balance billing is the practice of charging a plan holder for the difference between a provider's rate for a service and the in-network rate. First, the bill requires self-insured group health plans that cover emergency services to comply with the requirements for other types of group health plans. This includes the requirement to bill a plan holder no more than the in-network cost-sharing amount for covered emergency services, even if the provider is out-of-network. Second, the bill prohibits emergency services providers from billing a self-insured group plan holder for any remaining balance for covered services not paid to the provider by the employer. Further, unless a plan holder has the option to select an in-network provider, an out-of-network provider of covered, nonemergency services is prohibited from billing plan holders for the difference in rates for such services when provided at an in-network facility. Employers must pay out-of-network providers for services subject to the requirements of this bill (1) the amount the provider claims, (2) the usual and customary amount for such services in that community, or (3) an amount agreed to within 60 days of when the claim is submitted. Otherwise the parties may enter voluntary binding arbitration.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
May 1, 2019

Latest Companion Bill Action

S 116-1266
Introduced in Senate
Aug 30, 2019
Introduced in House
Aug 30, 2019
Referred to the House Committee on Education and Labor.
Sep 10, 2019
Sponsor introductory remarks on measure. (CR H7587-7588)
  • May 1, 2019

    Latest Companion Bill Action

    S 116-1266
    Introduced in Senate


  • August 30, 2019
    Introduced in House


  • August 30, 2019
    Referred to the House Committee on Education and Labor.


  • September 10, 2019
    Sponsor introductory remarks on measure. (CR H7587-7588)
Ross Spano

Ross Spano

Republican Representative

Florida

Education and Workforce Committee

Health

Related Bills

  • S 116-1266: Protecting Patients from Surprise Medical Bills Act
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Alternative dispute resolution, mediation, arbitrationEmergency medical services and trauma careHealth care costs and insurance