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Source: United States House of Representatives – Congressman Brian Higgins (Western District of New York)

Feb 13, 2020

Press Release

Congressman Brian Higgins (NY-26) announced the House Committee on Ways and Means has approved the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826).  The bipartisan legislation, cosponsored by Higgins, improves transparency and provides better protections for patients facing medical bills.

Higgins said, “Surprise medical bills for out-of-network care can be financially devastating for patients and their families. This legislation protects consumers from receiving surprise medical bills and removes the unfair mystery associated with billing, giving patients access to the information they deserve relative to the coverage they are entitled to under their plan and the costs they can expect to pay following care.”

The nonpartisan Congressional Budget Office reported that the legislation would reduce premiums and lower health costs.  Features of the bill include:

  • Requires insurers and providers to resolve billing claims directly, preventing consumers from receiving multiple confusing bills and statements
  • Insurers and providers must provide a good-faith cost estimate of health care services
  • Gives an enrollee information related to the amount incurred related to out-of-pocket thresholds & deductibles
  • Requires health plans to provide a price comparison tool
  • Consumers are provided estimated costs for out-of-network services
  • Provides working and retired Americans equal balance billing protections
  • Allows for the right to receive an Advance Explanation of Benefits
  • Insurance cards must provide more information relative to deductibles and cost-sharing details
  • Providers must share cost estimates directly with uninsured patients

The legislation is supported by both patient advocate and hospital organizations including: AARP, American Medical Association (AMA), American Heart Association, Leukemia & Lymphoma Society and the Healthcare Association of New York State.