How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing

As Congress and a number of states craft legislation to protect consumers from surprise out-of-network billing, a critical issue is resolving how insurers will pay out-of-network providers for their services. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR’s Jack Hoadley and Maanasa Kona assess the experience of states that use an independent dispute resolution process to determine these payments. Continue reading

Addressing Surprise Billing by Setting Payment Standards for Out-of-Network Providers

The thorniest issue in pending legislation to protect consumers from surprise medical billing is how to resolve disputes between payers and providers over appropriate payment. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR experts Maanasa Kona, Jack Hoadley, and Katie Keith examine the seven states that have adopted a payment standard for out-of-network bills. Continue reading

Update on Federal Surprise Billing Legislation: New Bills Contain Key Differences

Congressional leaders are racing to meet a self-imposed May deadline for passing legislation to protect consumers from surprise medical billing. In their latest post for the Commonwealth Fund’s To the Point blog, Jack Hoadley, Beth Fuchs, and Kevin Lucia identify key similarities and differences among competing proposals, and provide a comprehensive side-by-side guide to the key committee bills. Continue reading

The Texas Two-Step: Implementation of State Balance Billing Law Reveals Gaps in Consumer Protections

In Congress and state legislatures across the country, policymakers are debating fixes to surprise medical bills. The federal government has yet to enact comprehensive reforms, but a number of states have taken steps to protect consumers. One such state is Texas, which last year enacted a new law holding consumers harmless in situations that commonly lead to surprise medical bills. However, the state’s new protections were almost gutted due to an implementation loophole, a cautionary tale for federal and state policymakers. CHIR’s Rachel Schwab takes a look at what happened in Texas. Continue reading

New Resource for Consumer Advocates on Out-of-Network Payment Disputes in Balance Billing Legislation

State lawmakers across the country are are gearing up for a new legislative session. Many will be considering state-level protections for consumers to prevent surprise out-of-network medical bills. Just as with the federal legislation, however, one of the key sticking points for state policymakers will be how to approach out-of-network provider reimbursement. To aid stakeholders in these efforts, Community Catalyst teamed up with CHIR experts to create a guide for its health insurance reform toolkit: The Advocate’s Guide to Addressing Out-Of-Network Payment in Surprise Balance Billing Legislation. Continue reading

Disputes over Dispute Resolution: Analyses of New York & California-style Surprise Billing Protections Offer Divergent Pictures

The U.S. Congressional Budget Office (CBO) has a new analysis of legislation that would protect patients from surprise medical bills and help settle physician-insurer payment disputes through an arbitration process. CHIR’s Sabrina Corlette takes a look at their projections and three recent assessments of the effect of balance billing laws in New York and California Continue reading