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The following two federal actions could offer distinct forms of protection from surprise bills – from requiring that any amount paid toward a surprise bill must count toward the maximum out-of-pocket limit to holding patients financially harmless for any cost above in-network amounts. Both blue and red states have already started taking steps to protect consumers from these potentially devastating bills, but as we have outlined before, federal action is needed to protect all American consumers. In addition, the balance bill they pay typically is not protected by the insurance plan’s maximum out-of-pocket (commonly referred to by policy wonks as a “MOOP”) limit. Network matching: An attractive solution to surprise billing.
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Ruiz’s arbitration proposal for surprise billing (H.R. Not only are these patients charged the full, not-negotiated “chargemaster” rate, they usually must also must pay a greater portion of the charges because it is out-of-network care.Ĭomplete up-to-date Brookings’ resources on surprise billing are available here. Patients are unfairly surprised when they are billed by a provider not in their insurer’s network where they had no reasonable opportunity to choose a network provider. “Surprise” out-of-network bills are widely seen as an unfair aspect of today’s health care markets.