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Congress: Out-of-Network Becomes Top Priority

Following the introduction of legislation by Sen. Bill Cassidy, MD and the Senate working group in 2018, Sens. Jeanne Shaheen and Maggie Hassan of New Hampshire introduced bills that also aim to solve aspects of out-of-network and "surprise" billing. Sen. Shaheen's proposal, the Reducing Costs for Out-of-Network Services Act, seeks to address balance billing in the uninsured population and individual insurance market, while Sen. Hassan's proposal, the No More Surprise Medical Bills Act, seeks to address patients with employer-sponsored health plans. ASPS wrote letters to the Granite State Democrats urging them to work on a single, comprehensive piece of legislation that included less ambiguity and more answers for American patients.

Although the legislative branch is divided, out-of-network billing will continue to be one of Congress' top healthcare priorities over the next two years. With that in mind, ASPS proactively sent letters outlining the Society's top out-of-network priorities, along with the ASPS position statement on out-of-network billing, to the 30 health professionals currently serving in Congress. A similar letter was also sent to House Ways and Means Health Subcommittee members and House Ways and Means leadership. In those letters, ASPS recommends stronger federal network adequacy standards, holding patients harmless from amounts above in-network cost-sharing, retaining a balance billing option - especially in nonemergent situations, fair and timely payment as determined by the 80th percentile of billed amounts in a third-party database, and clearly addressing ERISA plans – which only the federal government has the authority to influence.

ASPS is poised to lead the way in shaping this legislation as it evolves at the federal level, just as the Society has done at the state level over the past several years.

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