Understanding Surprise Medical Bills

What are Surprise Medical Bills?

Surprise medical bills occur when an individual receives healthcare from an out-of-network provider without prior knowledge or consent. These bills can be particularly costly, as out-of-network providers are not bound by the same reimbursement rates as in-network providers.

New Bipartisan Legislation

Congress has recently drafted a bipartisan bill to address surprise medical billing. The key details of the bill include:

Benchmark Rate for Bills Under $750:

For bills under $750, insurers would pay providers at least the median in-network rates for that region. This method ensures that providers are fairly compensated while protecting patients from excessive charges.

Arbitration for Bills Over $750:

For bills over $750, insurers and providers would negotiate through a third-party arbitrator. This process aims to find a fair solution that considers both the provider’s reasonable charges and the patient’s ability to pay.

Who Wins, Who Loses?

The new bill is expected to have the following outcomes:

Providers: Providers may face lower reimbursements, especially for smaller bills.
Insurers: Insurers will have less leverage in negotiating larger bills, potentially leading to higher costs.
Patients: Patients will be relieved from unexpected and excessive medical bills.


The bipartisan legislation aims to protect patients from surprise medical bills while ensuring that providers are fairly compensated. The bill has a long way to go before it becomes law, but it represents a significant step towards addressing this issue.

Seeking Help with ACA Insurance

If you are uninsured or need assistance navigating ACA health insurance, it’s crucial to seek the advice of a licensed agent. Agents can guide you through the enrollment process, compare plans, and ensure that you have the most suitable coverage for your needs.

Don’t try to operate on HealthCare.gov by yourself. Call us for help.

Disclaimer: This blog is for informational purposes only and does not constitute medical or legal advice. Always consult with your healthcare provider or an insurance professional before making any decisions related to your health or coverage.

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