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How to best protect consumers from surprise medical bills

HANYS recently announced support for the House Committee on Ways and Means’ Consumer Protections Against Surprise Medical Bills Act.


HANYS and our New York hospitals and health systems have long been committed to protecting patients from surprise medical bills.

A lot of activity on surprise billing is happening in Washington right now. On Feb. 10, HANYS expressed our support for the House Committee on Ways and Means’ Consumer Protections Against Surprise Medical Bills Act, which advances our shared goal of protecting consumers from surprise medical bills while rejecting a federal benchmark rate.

As we said in our letter of support, we appreciate the House Committee on Ways and Means’ thoughtful approach to this issue, and we will continue to encourage members of Congress to support this bill and push for its swift passage.

Benchmark rates are bad for patients, bad for providers

Other active surprise billing proposals incorporate a fixed benchmark system, where the government sets the rate paid to providers. A federal benchmark rate would shift tremendous power into the hands of insurance companies at the expense of hospitals, health system and they patients they serve.

When health plans can rely on a government-mandated default rate, there is less incentive for them to maintain networks of providers because the default payment increases their leverage when negotiating with providers. Health plans will compel providers to take an arbitrary payment which may not reflect the cost of providing services, forcing the provider to make difficult choices on how to maintain services for their patients. Inevitably, this uneven playing field will impact patient choice and access. Patients benefit from inclusive networks, as these give them more access to care from more healthcare professionals.

It is critically important that the surprise billing solution signed into law rejects any benchmarking system. We can protect patients from surprise billing without giving such leverage to insurers. In fact, New York has done it quite well.

New York has led the way in consumer protections

HANYS and our members are proud to have played a key role in the passage and implementation of New York’s landmark Out-of-Network Consumer Protection Law, which holds patients harmless for emergency services and protects them from “balance bills.”

New York’s law requires that patients be insulated from disputes between health plans and providers; it does not use a benchmarking system.

See our complete guide to New York’s out-of-network consumer protection law

Since the law took effect in March 2015, it has saved patients hundreds of millions of dollars and has not had a negative impact on insurance premiums. Most New Yorkers now benefit from some of the strongest consumer protections in the nation. As the law only applies to state-regulated insurance plans, HANYS actively works at the federal level to ensure all New Yorkers become protected from surprise medical bills. We are proud to see the House Ways and Means Committee’s legislation advance as part of those efforts.

We will continue to engage with members of Congress as this important discussion moves forward and urge them to pass the Consumer Protections Against Surprise Medical Bills Act.

Patients should be protected from surprise bills. We’re committed to making sure they are.