H.R. 10788

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The Lower Premiums, Faster Payments Act modifies how private health insurance plans handle out-of-network medical billing and payment disputes. The bill eliminates the independent dispute resolution process for out-of-network claims through the end of 2027, then replaces it starting in 2028 with a new payment calculation based on median contracted rates from January 2019, adjusted annually for inflation. For insurance plans and coverage types that did not exist in 2019, the Secretary of Health and Human Services will establish alternative pricing methodologies. The bill requires the Secretary to issue updated regulations within 180 days and mandates annual audits of at least 25 health plans beginning in 2028, with audit results made public, while preventing courts from challenging the government's payment calculation methodology. These changes aim to standardize out-of-network payment rates and reduce surprise medical bills for patients covered by private insurance plans.

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