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WILMINGTON, Del. – Today, U.S. Senator Tom Carper (D-Del.), member of the Senate Finance Committee, hosted a roundtable with patient advocates to discuss the bipartisan STOP Surprise Medical Bills Act (S. 1531), legislation Senator Carper helped introduce in May to protect patients from surprise medical bills. This legislation is a product of a nearly year-long effort revising proposals and requesting feedback on draft legislation released last September by Senators Carper, Bill Cassidy (R-La.), Michael Bennet (D-Colo.), and Todd Young (R-Ind.) — and legislation first introduced last Congress by Maggie Hassan (D-N.H.).

 During today’s roundtable, Senator Carper was joined by representatives from the National Alliance on Mental Illness (NAMI) of Delaware, AARP Delaware, Leukemia and Lymphoma Society of Delaware, American Lung Association (ALA), Alzheimer’s Association, Brain Injury Association of Delaware, Breast Cancer Coalition of Delaware, American Heart Association (AHA), Delaware Autism, the National Association for Down Syndrome, the Delaware Insurance Commissioner’s office and the Department of Health and Social Services for the discussion.

 “When I come home to Delaware every day, it is sometimes difficult to explain complex legislation Congress is working on in Washington. But the issue of surprise medical bills is not hard for Delawareans to grasp,” said Senator Carper. “An estimated four out of 10 Americans receive medical bills that they didn’t plan for and, oftentimes, these bills can run well over $100,000. No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency. And Democrats and Republicans agree – we can do better. It’s why I’ve worked with my colleagues from both sides of the aisle on this legislation to protect patients from surprise medical bills. This bill takes the burden off of the patient. Put simply, patients should be able to focus on getting healthy rather than having to negotiate over their medical bills. Today, I’m proud to be here with patient advocates and Delawareans to discuss this common-sense legislation and figure out ways we can work together to fix this issue that is becoming all too common for too many families in our state and across the country.”

 “Access to affordable health care services is essential for many people with mental illness to successfully manage their condition and get on a path of recovery,” said Anne Slease, Director of Advocacy and Education for the National Alliance on Mental Illness (NAMI) in Delaware. “Yet surprise medical bills are an increasingly common concern for people seeking mental health services. People with mental health needs are often disproportionately impacted by surprise medical billing, especially when receiving inpatient psychological care. This comprises recovery and creates further barriers to mental health care. NAMI Delaware is grateful to Senator Carper for this important legislation and we look forward to bringing awareness of this issue to those we serve.”

 The STOP Surprise Medical Bills Act addresses three scenarios in which surprise medical billing (also known as “balance billing”) would be prohibited:

  • Emergency services:  The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.
  • Non-Emergency services following an emergency service at an out-of-network facility: This bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
  • Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.

Providers would automatically be paid the difference between the patient’s in-network cost-sharing amount and the median in-network rate for these services, but providers and plans would have the opportunity to appeal this payment amount through an independent dispute resolution process, should they see fit. This “baseball-style” process would entail the plan and provider submitting offers to an independent dispute resolution entity that has been certified by the Secretaries of HHS and the Department of Labor. This entity would make a final decision based upon commercially-reasonable rates for that geographic area.

The patient is completely removed from this process between the provider and the plan, and regardless of any outcome from a dispute resolution process, the patient still only owes the in-network rate. States that have established an alternate mechanism for protecting patients and determining payment amounts for providers would be able to continue with those systems.

On May 29, the Bipartisan Senate Working Group on surprise medical billing announced major growth in support for the STOP Surprise Medical Bills Act with 21 senators already cosponsoring the legislation less than two weeks after its introduction. Joining the Bipartisan Senate Working Group in cosponsoring the legislation were U.S. Senators Dan Sullivan (R-Alaska), Sherrod Brown (D-Ohio), Kevin Cramer (R-N.D.), Ben Cardin (D-Md.), John Kennedy (R-La.), Bob Casey (D-Pa.), Joni Ernst (R-Iowa), Sheldon Whitehouse (D-R.I.), Mike Braun (R-Ind.), Bob Menendez (D-N.J.), Lindsey Graham (R-S.C.), Jacky Rosen (D-Nev.), Cindy Hyde-Smith (R-Miss.), Tina Smith (D-Minn.), and Rob Portman (R-Ohio).