CAP Opposes Payment Scheme in No Surprises Act

After the Energy and Commerce Subcommittee on Health marked up HR 3630, the CAP urges the full committee to amend the bill to eliminate its rate-setting provision and replace it with an independent dispute resolution process.

WASHINGTON, DC—The College of American Pathologists (CAP) remains opposed to HR 3630, the No Surprises Act, due to the reimbursement benchmark requirement that relies on insurance industry-controlled median contracted rates for out-of-network services.

Despite repeated calls for changes to the physician pay mechanism for out-of-network services in HR 3630, the bill marked up by the Energy and Commerce Subcommittee on Health fails to include an independent dispute resolution process that’s successfully proven to keep patients from receiving surprise medical bills in several states. The CAP and other physician specialty associations warn that HR 3630’s reliance on rate setting for out-of-network services will create imbalance and threaten patient access in the US 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.

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.