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CAP Cites Concerns Over Payment Formula for Out-of-Network Services in Senate Bill

Following the HELP Committee mark up of S. 1895, the CAP urges senators to amend the bill to eliminate its rate-setting provision and include arbitration.

WASHINGTON, DC—The College of American Pathologists (CAP) remains opposed to S. 1895, the Lower Health Care Costs Act, due to the reimbursement benchmark requirement that would use median contracted rates for out-of-network services.

Despite increased calls for changes to the physician pay mechanism for out-of-network services in S. 1895, the Senate Health, Education, Labor, and Pensions (HELP) Committee marked up its bill without adding an independent dispute resolution process that’s successfully kept patients from receiving surprise medical bills in several states. The CAP and other physician specialty associations warn that S. 1895’s reliance on rate setting for out-of-network services will create imbalance and threaten patient access in the U.S. health care system.

The root cause of a surprise medical bill is a health insurance plan with an insufficient provider network. Independent arbitration systems work by financially protecting patients and reducing out-of-network costs. In addition to arbitration, the CAP asks Congress to require network adequacy standards for health insurers as part of the holistic solution to address the problem of surprise billing.

About the College of American Pathologists

As the world's largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, visit yourpathologist.org to watch pathologists at work and see the stories of the patients who trust them with their care. Read the 2018 CAP Annual Report at CAP.ORG.