Letter to Senate Health, Education, Labor and Pensions Committee on Surprise Billing
Dear Chairman Alexander and Ranking Member Murray:
Employers are greatly concerned about the toll that unexpected and oftentimes significant
medical bills can place on working families. When facility-based physicians decline to
participate in networks, the amount they can bill for services is unlimited. Surprise medical bills
from out-of-network anesthesiologists, pathologists, emergency room physicians and radiologists
impose unanticipated significant bills on patients. In most instances, the patient is seeking
treatment at an in-network facility when these out-of-network facility-based physicians perform
ancillary services. While many employers protect employees and their families from balance
billing in these situations and offer assistance to patients faced with a surprise bill, the underlying
problems persist, and undermine employer and patient efforts to seek better health care value and
We urge Congress to consider the following principles in crafting legislation to protect patients
from surprise medical bills without undermining access to high-quality, value-based health care
networks. We recognize the complexity of the task and believe that federal legislation in keeping
with these principles can bring better care to the 181 million Americans who receive health
insurance through an employer-sponsored plan.
- End surprise billing: Any effort must begin with eliminating balance billing by
emergency providers, out-of-network (OON) providers at in-network facilities, and
providers who consistently produce surprise bills under the current system.
- Promote better quality and lower cost for consumers: Health plan networks
promote better quality and lower costs for consumers. Federal legislation to address
surprise billing should not incentivize providers to continue to reject network
participation. Solutions to surprise billing should serve to lower, not increase,
premiums and costs for consumers. We are concerned that mandated arbitration
would not only raise costs and undermine network participation, it would also be an
inefficient and ineffective method of addressing surprise billing.
- Require Transparency: Patients and consumers have a right to be adequately
informed of potential health care charges and to authorize any non-emergency
treatment for which they will be billed by an OON facility-based physician at an in-network
hospital. Facility-based physicians should disclose cost and quality data so
patients can make informed choices about treatment.
- Preserve National Uniformity: The National Coalition on Benefits is a coalition of
business and associations established to protect the ability of employers to provide
uniform health and retirement benefits to employees and retirees across the country.
ERISA provides the framework that allows employers and employees to benefit from
reduced costs that come from uniformity in plan design and administration without
the burdens of a patchwork of state and local laws. We are concerned about any
legislative change that affects uniformity in plan offerings for our employees and
their families. Federal legislation should not require employers to comply with state
laws that govern the offering of health coverage to employees. Self-insured plans
must not be subject to state laws relating to surprise OON billing, including with
respect to state mandatory binding arbitration or payment requirements.
- Protect Value-Based Payment Arrangements: Any legislation should be crafted in
a way that ensures that value-based payment arrangements, which depend on provider
participation in networks, are not hindered through unintended consequences of the
law. These programs and benefit designs help reduce costs and improve patient
Thank you for your consideration of these principles. We look forward to working with you and
other stakeholders toward a viable solution to the burden of surprise medical billing.
The National Coalition on Benefits
cc: Members, Committee on Health, Education, Labor & Pensions
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