AFFORDABLE HEALTHCARE SCORECARD ALERT – Protection Against Surprise Billing

April 15, 2021

A North Carolina General Assembly proposal (Senate Bill 415) would protect patients from surprise medical bills received in emergency situations and from out-of-network providers at in-network facilities.

The Coalition SUPPORTS to this legislation.

Surprise billing is the biggest issue facing healthcare consumers today. 1 in ten Americans have been a victim of a surprise medical bill received from an out-of-network provider. And it drives up costs by roughly $40 billion a year.

Senate Bill 415 addresses this problem by setting a fair and reasonable benchmark payment for out-of-network care received at an in-network facility or an emergency room. Research shows benchmarking is the best solution to surprise billing.

Under this legislation, the patient’s insurer must pay the out-of-network provider the lesser of three options:

  1. The same amount the insurer would pay for the service if the patient was on Medicare.
  2. The provider’s actual charges.
  3. The median contracted rate in the insurer’s network for the same or similar services.

The provider gets to accept that amount as payment in full. 

The insurer pays. The provider accepts. The patient is protected.

Actions related to this bill will be factored into a member’s Affordable Healthcare Grade at the close of the legislative session.


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