In the News

Surprise medical bills — ones sent to people who receive care outside their insurer’s network, often without knowing it until later — could be headed to arbitration under bipartisan compromise legislation hashed out last week by U.S. Rep. Richard E. Neal and others.

“This was a significant breakthrough,” Neal said Monday. “The incentive there clearly is for the parties to avoid arbitration.”

Neal said he hopes surprise medical billing legislation is part of COVID-19 relief legislation now talking shape in Washington and set to pass in the next week.

Arbitration could be winner-take-all, he said. The hope is that providers, insurers and consumers can work out a compromise.

“It’s sizable legislating achievement,” said Neal, D-Springfield, chairman of the powerful House Committee on Ways and Means.

Neal’s opponent in the fall’s Democratic primary, Holyoke Mayor Alex B. Morse, used the surprise medical billing issue against him, saying Neal helped shelve a competing solution about a year ago.

That plan, Neal said, was skewed too favorably toward insurance companies and would have hurt hospitals and providers. Detractors said Neal was responding to the concerns of corporate campaign donors by blocking progress on the matter.

Neal’s position was backed by hospitals, including Springfield’s Baystate Health. A similar arbitration program is in place in New York, where Neal said it has worked well.

The agreement would hold patients harmless from surprise medical bills, including from air ambulances, by ensuring they are only responsible for their in-network cost-sharing amounts, including deductibles, in both emergency situations and certain non-emergency situations where patients do not have the ability to choose an in-network provider. Air ambulance charges had been a sticking point.

The deal prohibits certain out-of-network providers from billing patients, unless the provider gives the patient notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services and the patient provides consent to receive out-of-network care.

Monday, the New York Times editorial page used surprise medical billing as an example of pressing needs Congress needs to address. It said House Speaker Nancy Pelosi had asked Neal to compromise.

Neal on Monday said that wasn’t exactly what happened, and that discussion among leaders has been ongoing. He learned Thursday on his way to the airport that an agreement had been reached.

On board are House Republican leader Kevin Brady of Texas; House Energy and Commerce Committee Chairman Frank Pallone Jr., D-N.J., and Ranking Member Greg Walden, R-Ore.; House Education and Labor Committee Chairman Robert C. “Bobby” Scott, D-Va., and Ranking Member Virginia Foxx, R-N.C.; and Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander, R-Tenn., and Ranking Member Patty Murray, D-Wash.

Alexander is leaving the Senate at the end of this term, but Neal said he has spoken with Louisiana Republican Sen. Bill Cassidy, who is in line to take over the role.