Congress set to ban surprise medical billing in year-end spending package

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Congress is poised to include a ban on "surprise" medical bills as part of its massive year-end spending package that lawmakers are expected to vote on Monday.

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In a joint statement Sunday night, House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer confirmed that "bipartisan, bicameral legislation that will end surprise billing for emergency and scheduled care" will be part of $1.4 trillion spending bill, which also includes an additional $900 billion in coronavirus relief money.

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“We're very proud that surprise billing is a part of this,” Pelosi said Sunday night.

The long sought-after legislation will protect insured patients from receiving expensive medical bills when they inadvertently receive out-of-network care. Americans of all stripes support the effort: A survey published Friday by the Kaiser Family Foundation found that 80% of adults support abolishing the practice.

Although lawmakers in both parties had been pushing for a plan to fix the issue for years — with the support President Trump, who had made it a key campaign priority – the effort drew fierce opposition from powerful lobbying groups representing the health care industry, who questioned how much the insurer would have to pay the doctor once the patient was removed from the equation.

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A previously announced deal called for health insurers and providers to negotiate most billing disputes or bring their complaints to a mediator. The final legislation moves even further in favor of doctors and hospitals by preventing the arbiter from using the lower payment rates paid by Medicaid and Medicare programs, according to Politico, which obtained a copy of the bill summary.

Lawmakers also diluted a measure that would have required health insurers to disclose information to employers about their drug costs and rebates through their contracts with middlemen known as pharmacy benefit managers. The legislation now calls for insurers to submit more general information on medical costs and prescription rug spending, according to Politico.

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Rep. Richard Neal, chairman of the House Ways and Means Committee, called the proposal a "win for patients and their families that will improve America's health care system."

An earlier clash between Neal, who had previously blocked proposals to stop surprise medical billing, and three other committees — House Energy and Commerce, House Education and Labor and Senate Health, Education, Labor and Pensions — threatened to derail the reform efforts. After securing changes that were friendlier to doctors and hospitals, however, Neal agreed to support the proposal.

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