Surprise Billing Final Rule Must Provide Real Protection for Patients

Washington, DC – The ERISA Industry Committee (ERIC) provided comments on the Biden Administration’s Interim Final Rule “Requirements Related to Surprise Billing; Part I.”

“It is vital that the final rule allows the No Surprise Act to be implemented as Congress intended, while also safeguarding patients from surprise medical bills, lowering costs, and strengthening employer-sponsored health insurance for millions of Americans and their families,” said James Gelfand, Executive Vice President, Public Affairs, ERIC.

ERIC’s comments focused on the Qualifying Payment Amount (QPA), which will lower patient costs and ensure fair market payment by minimizing reliance on outside resources, such as state all-payer claims databases. Additionally, the Final Rule addresses the difference in geographic regions and insurance markets, ensuring that payment amounts are determined using locally negotiated rates that reflect the market conditions where a patient receives care.

ERIC also appreciates provisions that protect patients from surprise bills issued by out-of-network providers at an in-network facility by requiring a 72-hour notice period. Patients will be better informed going into an appointment, enabling them to seek out in-network options that will not levy additional charges.

However, ERIC cautions the Administration to consider if urgent care centers are likely to include costly out-of-network services like labs or radiology. If so, then ERIC urges the Administration to designate the centers as emergency departments to reduce confusion about classification as it currently varies state by state.

As ERIC awaits additional surprise billing rules that address the independent dispute resolution (IDR) process, ERIC also requests that IDR be used as a last resort for those cases that cannot be negotiated. The IDR process, if overused, poses risks to patient access and affordability, and these risks run counter to Congress’s legislative intent in developing and passing the No Surprises Act.

“Surprise medical bills serve only one purpose, and that is to make money off of unsuspecting Americans in their time of need. The Administration’s Final Rule must be firm in its intent to end this predatory practice and protect all Americans,” said Gelfand.

Click here to read ERIC’s comments.

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All media inquiries to The ERISA Industry Committee should be directed to:

Kelly Broadway, 202.627.1918, kbroadway@eric.org

About The ERISA Industry Committee
ERIC is a national advocacy organization that exclusively represents large employers that provide health, retirement, paid leave, and other benefits to their nationwide workforces. With member companies that are leaders in every sector of the economy, ERIC advocates on the federal, state, and local levels for policies that promote flexibility and uniformity in the administration of their employee benefit plans.