来自众议院能源与商业委员会民主党首席议员弗兰克·帕洛内二世（新泽西州）的新法案，旨在彻底改革一项保护患者免受意外医疗账单困扰的法律的关键部分。这项新法案的目标是解决帕洛内及批评者所称的保险公司与医疗服务提供者之间存在缺陷的争议解决机制。帕洛内曾参与起草的《无意外账单法》（No Surprises Act）建立了一套仲裁程序，用于处理医疗服务提供者和支付方之间的支付纠纷。
New legislation from Rep. Frank Pallone Jr. (N.J.), the top Democrat on the powerful House Energy and Commerce Committee, aims to overhaul a key part of a law that protects patients from surprise medical bills. The new bill aims to fix what Pallone and critics say is the flawed dispute resolution system between insurers and providers. The No Surprises Act, which Pallone helped write, established an arbitration process between healthcare providers and payers when there is a payment dispute.
根据该法律，医疗服务提供者可以申请仲裁，并在仲裁中主张远高于他们原本能从健康保险计划中获得的支付金额。尽管该法能防止患者收到来自非网络内提供者的意外账单，但这些被过度夸高的支付最终仍会通过更高的保费或更少的福利转嫁到患者身上。帕洛内表示，少数组织——主要由私募股权投资公司支持——占据了通过仲裁程序提交的大多数争议；这些公司正在大量收购麻醉科、放射科和急诊室等医疗诊所。
The law allows providers to file for arbitration, where they are able to make a case for much higher payments than they could otherwise receive from health plans. While the law keeps patients from receiving a surprise bill from an out-of-network provider, the overinflated payments get passed to them anyway through higher premiums or fewer benefits. According to Pallone, a small number of organizations, mostly backed by private equity firms — which are buying up medical practices like anesthesiology, radiology and emergency rooms — account for the majority of disputes filed through the arbitration process.
2025年提交的250万起争议中，约有67%仅由10家医疗服务机构提出。帕洛内的法案——《降低保费、加快支付法》（Lower Premiums, Faster Payments Act）——将用一种名为“基准定价”（benchmarking）的机制取代仲裁制度。根据这一机制，即使医疗服务提供者属于非网络内机构，其服务费用也将按照经地理因素调整后的网络内中位数费率支付。
Of the 2.5 million disputes submitted in 2025, approximately 67 percent were submitted by just 10 provider groups. Pallone's bill — the Lower Premiums, Faster Payments Act — will replace the arbitration system with something called “benchmarking,” which stipulates that providers would be paid at the median in-network rate for their services, adjusted for geography, even if they were out-of-network. “The No Surprises Act has been an overwhelming success when it comes to protecting patients from surprise medical bills,” Pallone said in a statement.
“《无意外账单法》在保护患者免受意外医疗账单方面取得了巨大成功，”帕洛内在一份声明中表示，“但遗憾的是，仲裁机制显然并未奏效。少数不良行为者——主要由私募股权投资公司支持——正在操纵这一体系，导致案件积压、支付延迟以及保费上涨。”在“棒球式”仲裁程序中，保险公司和医疗服务提供者各自为某项服务提出一个费率。
“[U]nfortunately the arbitration process is clearly not working. A few bad actors—largely backed by private equity—are gaming the system, creating backlogs, delaying payments, and driving up premiums.”Under the “baseball style” arbitration process, insurers and providers each propose a rate for a given service.
没有谈判的余地，仲裁员必须从建议的数值中选择一个。帕洛内从一开始就支持基准法方法，但为了推动该法案通过并签署成法，他做出了妥协。如果民主党赢得众议院，他有望明年担任能源与商业委员会主席，届时他将能够优先处理自己的法案。医疗服务提供者和健康保险计划都相互指责对方导致消费者医疗成本高昂。
There's no room for negotiation, and an arbitrator must choose one of the suggested figures. Pallone supported the benchmarking approach from the start but compromised to get the legislation passed and signed into law. He is poised to be Energy and Commerce Committee chair next year if Democrats win the House, putting him in position to prioritize his bill. Both providers and health plans blame each other for high consumer health costs.
医疗服务提供者认为需要进行仲裁，因为保险公司提供的报销率具有误导性且不切实际，而保险公司和一些消费者倡导组织则更倾向于基准法。帕洛内的法案为医疗服务提供者提供了一些好处，例如确保他们在30天内获得付款。《无意外法案》的通过得到了该问题各方的大力游说，尽管众议院和参议院的议员中有人希望重新审议该法案，但同样的势力也将在下一届国会针对任何新的努力施加影响。
Providers argue arbitration is needed because insurers offer misleading and unrealistic reimbursement rates, while insurers and some consumer advocacy groups prefer benchmarking. Pallone’s bill includes some benefits for providers, such as ensuring that they are paid within 30 days. Passage of the No Surprises Act was heavily lobbied by all sides of the issue, and while there is some appetite among House and Senate lawmakers to revisit, those same forces will be brought to bear on any new effort in the next Congress.