Surprise Billing Final Rule Part II Offers Cost Savings and Consumer Protections

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

ERIC’s comments focused on the safeguards and the cost-savings the Interim Final Rule will provide patients. ERIC highlighted how the design of the independent dispute resolution process and use of an external review would protect employer-sponsored health insurance and lower premiums by up to one percent.

“A top priority for ERIC is preserving safeguards for consumers, patients, employees, and families under the ‘Requirements Related to Surprise Billing; Part I and II.’ We believe the Interim Final Rule offers that protection while lowering costs for employer-sponsored health insurance. The savings in premiums will allow employers to increase or offer new benefit designs to their employees, instead of spending on the resolution process,” said Annette Guarisco Fildes, President and CEO, ERIC.

ERIC acknowledged that the only way to achieve cost savings is by maintaining the qualified payment amount as the primary overriding consideration when determining the amount owed during the resolution process. The Interim Final Rule would do just that by requiring the certified independent dispute resolution entity to start with the belief that the qualified payment amount is the appropriate out-of-network rate for the disputed item or service. The entity would have to choose the offer closest to the qualified payment amount unless it determined that the amount is “materially different” from the appropriate out-of-network rate. ERIC believes utilizing the qualified payment amount offers predictability for plan sponsors and can encourage parties to reach an agreement outside of the resolution process.

“For too long, Americans have had to pay for overly inflated medical services. This predatory practice must stop, and that is why ERIC is calling on the Administration to have the protections provided by the Interim Final Rules take effect as intended on January 1, 2022,” said Guarisco Fildes.

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.