Surprise Billing Compromise Lowers Arbitration Threshold, Keeps Previous Benchmark

By Ariel Cohen / December 9, 2019 at 2:05 PM
The House and Senate surprise billing compromise sets a benchmark payment rate for out-of-network bills at the median in-network rate for a geographic area, and the insurer or provider can move to an independent dispute resolution process if the median in-network payment is above $750. For surprise bills resulting from air ambulances, the legislation sets the threshold for going to arbitration at $25,000. The House Energy & Commerce and Senate health committees’ compromise is similar to legislation passed earlier by...

Not a subscriber? Sign up for 30 days free access to exclusive, detailed reporting on drug pricing reforms, Medicaid policy, FDA news and much more.