3.0.0 1266 2022-03-02T16:28:31Z 2022-03-02T16:28:31Z Senate S 2019-05-01 116 sshr00 Health, Education, Labor, and Pensions Committee Senate Standing Referred to 2019-05-01T16:04:16Z 116 4223 HR 2019-09-10 Sponsor introductory remarks on measure. (CR H7587-7588) Identical bill CRS 2019-05-01 sshr00 Health, Education, Labor, and Pensions Committee Senate Read twice and referred to the Committee on Health, Education, Labor, and Pensions. IntroReferral 2019-05-01 Introduced in Senate IntroReferral 10000 9 Library of Congress S001217 Sen. Scott, Rick [R-FL] Rick Scott R FL N Health Alternative dispute resolution, mediation, arbitration Emergency medical services and trauma care Health care costs and insurance Health

00 2019-05-01 Introduced in Senate 2020-10-24T19:43:56Z Protecting Patients from Surprise Medical Bills Act

This bill prohibits balance billing the holder of a self-insured group health plan (plans in which an employer pays claims to providers for health benefits offered to employees) for emergency and specified nonemergency services. Balance billing is the practice of charging a plan holder for the difference between a provider's rate for a service and the in-network rate.

First, the bill requires self-insured group health plans that cover emergency services to comply with the requirements for other types of group health plans. This includes the requirement to bill a plan holder no more than the in-network cost-sharing amount for covered emergency services, even if the provider is out-of-network. Second, the bill prohibits emergency services providers from billing a self-insured group plan holder for any remaining balance for covered services not paid to the provider by the employer.

Further, unless a plan holder has the option to select an in-network provider, an out-of-network provider of covered, nonemergency services is prohibited from billing plan holders for the difference in rates for such services when provided at an in-network facility.

Employers must pay out-of-network providers for services subject to the requirements of this bill (1) the amount the provider claims, (2) the usual and customary amount for such services in that community, or (3) an amount agreed to within 60 days of when the claim is submitted. Otherwise the parties may enter voluntary binding arbitration.

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Display Title Short Title(s) as Introduced Introduced in Senate IS Official Title as Introduced Introduced in Senate IS Introduced in Senate 2019-05-01T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-116s1266is/xml/BILLS-116s1266is.xml 2019-05-01 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.