Suozzi, Wenstrup “Dear Colleague” Letter Opposes IDR Provisions in Surprise Billing Guidance

October 25, 2021

Representatives Tom Suozzi (D-NY) and Brad Wenstrup (R-OH) are circulating a “Dear Colleague” letter asking the Biden Administration to revise the interim final rule with comment period to create a more balanced independent dispute resolution (IDR) process between providers and insurers that better reflects Congressional intent.

Under the No Surprises Act, when arbitrating disputes over payment for out-of-network services, the IDR entity must consider several factors to determine the reasonableness of the proposed payments—one of which is the plan’s median in-network rate. The interim final rule, however, instructs IDR entities to presume that the median in-network rate is appropriate prior to considering other factors.

The Suozzi-Wenstrup letter opposes the guidance’s directive making the median in-network rate the primary factor and requests that the Administration revise the guidance so that the IDR entity would consider all factors outlined in the statute without disproportionately weighting the median in-network rate. The letter also states that the guidance’s IDR provisions do not reflect Congress’s original intent and essentially establish a de-facto benchmark rate that incentivizes insurance companies to set artificially low payment rates, potentially jeopardizing patients’ access to care.

GNYHA thanks Representatives Suozzi and Wenstrup for their efforts on this issue and encourages House members to sign the letter.

GNYHA will submit detailed comments on the surprise billing guidance to the Biden Administration.