,,ii  #aafth ,,congress  #ast ,session  
,s4 #aeca  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #af1 #bjai
 ,mr4 ,cassidy 7for himself1 ,mr4       
,bennet1 ,mr4 ,young1 ,ms4 ,hassan1 ,ms4
 ,murkowski1 ,mr4 ,carper1 ,mr4         
,sullivan1 ,mr4 ,brown1 ,mr4 ,cramer1   
,mr4 ,cardin1 ,mr4 ,kennedy1 and ,mr4   
,casey7 introduced the following bill2  
which was read twice and referred to the
 ,committee on ,health1 ,education1     
,labor1 and ,pensions  ,a ,,bill  ,to   
amend the ,public ,health ,service ,act 
to provide protections for health       
insurance consumers from surprise       
billing4  #a4 ,short title ,this ,act   
may be cited as the ,stopping ,the      
,outrageous ,practice of ,surprise      
,medical ,bills ,act of #bjai or the    
,,stop ,surprise ,medical ,bills ,act of
 #bjai4  #b4 ,findings ,congress makes  
the following findings3  7#a7 ,consumers
 frequently struggle to determine when  
and how much they will pay for a medical
 service or procedure4 ,a majority of   

consumers say health care providers     
rarely1 if ever1 discuss costs of       
recommended treatments and whether these
 treatments are covered by health       
insurance4 ,almost #gj percent of       
patients who receive bills from         
out-of-network providers did not realize
 the provider was out-of-network at the 
time of treatment4 ,patients using      
in-network facilities still receive     
claims from out-of- network providers at
 high rates1 over #ae percent of        
inpatient admissions and #e percent of  
outpatient service days4 ,even when     
patients try to schedule an in-network  
procedure at an in-network hospital and 
try to ensure that all providers who    
administer treatment will be in-network1
 they may be sent a balance bill by an  
out-of-network provider after receiving 
care4 ,if providers accepted the same   
health plans as the facilities at which 
they practice and administer care1      
out-of-network surprise medical bills   
would not be a complication for         

consumers scheduling elective           
procedures4  7#b7 ,surprise medical     
bills affect a sizeable portion of the  
insured population4 ,approximately #cj  
percent of individuals covered by       
private health insurance have received a
 surprise medical bill within the past  
year4 ,almost #bj percent of inpatient  
admissions by enrollees in large        
employer plans include at least #a claim
 from an out-of-network provider1 while 
#h percent of outpatient service days   
include an out-of-network claim4  7#c7  
,surprise medical bills are an issue of 
particular concern to consumers4 ,a     
majority of ,americans feel that        
softening the impact of surprise medical
 bills should be a priority for the     
current ,congress4 ,eighty-six percent  
of ,americans think it is important to  
protect individuals from surprise       
medical bills4  7#d7 ,surprise medical  
bills for emergency care are frequently 
unavoidable due to the emergent and     
serious nature of the patient's         

condition at the time of treatment4 ,one
 in #e cases of inpatient hospital      
admissions that originate within the    
emergency department result in a        
surprise medical bill4 ,for inpatient   
admissions1 those that include an       
emergency room claim are much more      
likely to include a claim from an       
out-of-network provider than admissions 
without an emergency room claim4 ,this  
is true whether or not enrollees use    
in-network facilities4 ,most cases of   
surprise medical billing occur when     
privately insured individuals           
involuntarily see out-of-network        
providers during medical emergencies4   
7#e7 ,the financial implications of     
surprise medical bills can be           
devastating for ,american consumers and 
can prevent them from seeking timely    
follow-up care or from accessing        
necessary services4 ,approximately #bj  
percent of insured ,americans struggle  
to pay their medical bills4 ,almost a   
third of consumers who report they are  

struggling to pay a medical bill also   
report this bill was due to charges from
 an out-of-network provider that were   
not covered or were only partially      
covered by their insurer4 ,consumers    
with outstanding medical bills report   
delaying or skipping needed health care 
at rates #b to #c times higher than     
consumers without outstanding bills4    
,over #fj percent of consumers with     
outstanding medical bills report        
difficulties paying other bills         
7including necessities such as food1    
heat1 or housing costs7 as a result of  
their medical bills4  #c4 ,prohibition  
on surprise balance billing and         
independent dispute resolution with     
respect to out-of-network health care   
services  7a7 ,in general ,subpart ,,ii 
of part ,a of title ,,xxvii of the      
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg et seq47 is amended by
 adding at the end the following3       
#bgbi;,a4 ,general prohibition on       
surprise balance billing  7a7 ,surprise 

medical bill ,in this title1 the term   
surprise medical bill means a balance   
bill1 as described in subsection 7b71   
that an enrollee receives for services  
provided to the enrollee where such     
services were-- 7#a7 emergency services 
provided by an out-of-network health    
care professional or at an              
out-of-network facility2  7#b7 health   
care services that were provided-- 7,a7 
at an in-network facility 7including the
 use of equipment1 devices1 telemedicine
 services1 or other treatments or       
services72 and  7,b7 by an              
out-of-network health care professional2
 or  7#c7 additional health care        
services required in the case of an     
enrollee who initially enters a hospital
 through the emergency room for         
emergency services1 and then receives   
nonemergency services from an           
out-of-network health care professional 
or at an out-of-network hospital or     
facility after the enrollee has been    
stabilized 7as defined in section       

#bgai;,a7b77#b77;,c771 as determined by 
the treating physician4  ,paragraph 7#c7
 shall not apply in the case of an      
enrollee who is stabilized and able to  
travel in nonmedical transport1 and the 
enrollee 7or designee of the enrollee   
where the enrollee is not able to       
comprehend the information to be        
provided or make related decisions7 has 
been provided with clear1 written       
notification that the professional or   
facility is an out-of-network health    
care professional or facility1 has been 
given a cost estimate for services      
provided by the out-of-network          
professional or facility1 and has       
assumed1 in writing1 full responsibility
 for out-of-pocket costs associated with
 such out-of-network care4  7b7 ,balance
 bill ,in subsection 7a71 the term      
balance bill refers to a claim for      
payment for services provided to an     
enrollee that is in an amount equal to  
the difference between the actual amount
 charged with respect to services or    

care described in subsection 7a7 and the
 expected in-network cost-sharing       
required by the enrollee under the plan 
or coverage involved4  7c7 ,prohibition 
on balance billing  7#a7 ,prohibition   
7,a7 ,in general ,a group health plan1 a
 health insurance issuer in connection  
with group or individual health         
insurance coverage1 or a health care    
provider shall not engage in balance    
billing practices prohibited under this 
section4  7,b7 ,application of          
provisions ,subparagraph 7,a7 shall     
apply-- 7i7 to all services provided at 
hospitals1 emergency rooms1             
,state-accredited free-standing         
emergency departments1 hospital         
outpatient departments1 and ambulatory  
surgery centers2 and  7ii7 with respect 
to subsection 7a77#b71 to the health    
care provider's offices and related     
services 7including laboratory and      
imaging services ordered by an          
in-network provider and provided by an  
out-of-network provider or laboratory74 

7#b7 ,enrollee liability ,with respect  
to the services and care described in   
subsection 7a71 an enrollee shall only  
be liable for the in-network            
cost-sharing amount provided for in     
their plan or coverage4 ,for purposes of
 this section1 such payments by the     
enrollee shall count toward the         
in-network deductible under the plan or 
coverage as well as toward the          
enrollee's out-of-pocket maximum        
limitation4  7#c7 ,penalty ,violations  
of this section shall subject the       
violator to a civil monetary penalty as 
provided for in this title4 ,such       
provisions shall not apply to a health  
care provider1 group health plan1 or    
health insurance issuer that unknowingly
 balance bills an enrollee and          
reimburses such enrollee within #cj     
calendar days of such billing4          
#bgbi;,b4 ,out-of-network billing  7a7  
,prohibition  7#a7 ,in general ,an      
enrollee may not be billed in excess of 
the in-network cost-sharing amount for  

services or care provided under section 
#bgbi;,a 7a surprise medical bill       
situation74  7#b7 ,automatic payment    
7,a7 ,in general ,a group health plan1  
or health insurance issuer in connection
 with group or individual health        
insurance coverage1 shall pay the median
 in-network rate under the plan or      
coverage1 less the applicable enrollee  
in-network cost-sharing1 directly to the
 health care provider as provided for in
 this section4  7,b7 ,request for       
alternative rate ,upon payment under    
subparagraph 7,a71 the plan or issuer   
shall provide to the health care        
provider information about how the      
provider may initiate independent       
dispute resolution under such subsection
 with respect to such payment4 ,the     
plan1 issuer1 or provider may negotiate 
an alternative amount or initiate       
independent dispute resolution under    
subsection 7b7 during the #cj-;day      
period beginning on the date on which   
the automatic payment is made under this

 subsection4  7b7 ,establishment of     
,,idr process2 certification of entities
  7#a7 ,establishment ,not later than #a
 year after the date of enactment of    
this section1 the ,secretary1 in        
consultation with the ,secretary of     
,labor1 shall establish a process for   
resolving payment disputes between group
 health plans1 or health insurance      
issuers offering health insurance       
coverage in the group market1 and       
out-of-network health care providers in 
surprise medical bill situations in     
accordance with this section 7referred  
to in this section as the ,,idr         
process74  7#b7 ,certification of       
entities ,an entity wishing to          
participate in the ,,idr process under  
this subsection shall request           
certification from the ,secretary4 ,the 
,secretary1 in consultation with the    
,secretary of ,labor1 shall determine   
eligibility of applicant entities1      
taking into consideration whether the   
entity is unbiased and unaffiliated with

 health plans and providers and free of 
conflicts of interest1 in accordance    
with the ,secretary's rulemaking on     
determining criteria for conflicts of   
interest4  7#c7 ,,idr entity ,under the 
process established under paragraph     
7#a71 the parties in the independent    
dispute resolution process shall jointly
 agree upon an independent dispute      
resolution entity4 ,in the event that   
parties cannot agree1 one will be       
selected at random jointly by the       
,department of ,health and ,human       
,services and the ,department of ,labor4
  7c7 ,applicable claims  7#a7 ,in      
general ,the ,,idr process shall be with
 respect to one or more ,current        
,procedural ,terminology 7,,cpt7 codes4 
7#b7 ,batching of claims ,health care   
facilities and providers and group      
health plans or health insurance issuers
 may batch claims if such claims-- 7,a7 
involve identical plan or issuer and    
provider or facility parties2  7,b7     
involve claims with the same or related 

current procedural terminology codes    
relevant to a particular procedure2 and 
7,c7 involve claims that occur within   
#cj days of each other4  7d7            
,independent dispute resolution process 
7#a7 ,timing ,an independent dispute    
resolution entity that receives a       
request under this section shall1 not   
later than #cj days after receiving such
 request1 determine the amount the group
 health plan1 or health insurance issuer
 offering health insurance coverage in  
the group market1 is required to pay the
 out-of-network health care provider4   
,such amount shall be-- 7,a7 the amount 
determined by the parties through a     
settlement under paragraph 7#b72 or     
7,b7 the amount determined reasonable by
 the entity in accordance with paragraph
 7#c74  7#b7 ,settlement  7,a7 ,in      
general ,if the independent dispute     
resolution entity determines1 based on  
the amounts indicated in the request    
under this section1 that a settlement   
between the group health plan1 or health

 insurance issuer offering health       
insurance coverage in the group market1 
and the out-of-network health care      
provider is likely1 the independent     
dispute resolution entity may direct the
 parties to attempt1 for a period not to
 exceed #aj days1 a good faith          
negotiation for a settlement4  7,b7     
,timing ,the period for a settlement    
described in subparagraph 7,a7 shall    
accrue towards the #cj-;day period      
required under paragraph 7#a74  7#c7    
,determination of amount  7,a7 ,final   
offers ,in the absence of a settlement  
under paragraph 7#b71 the group health  
plan1 or health insurance issuer        
offering health insurance coverage in   
the group market1 and the out-of-network
 health care provider shall each submit 
to the independent dispute resolution   
entity their final offer4 ,such entity  
shall determine which of the #b amounts 
is more reasonable based on the factors 
described in subparagraph 7,d74  7,b7   
,final decisions ,the amount that is    

determined to be the more reasonable    
amount under subparagraph 7,a7 shall be 
the final decision of the independent   
dispute resolution entity as to the     
amount the group health plan1 or health 
insurance issuer offering health        
insurance coverage in the group market1 
is required to pay the out-of-network   
health care provider4  7,c7 ,service    
units ,a final determination under      
subparagraph 7,b7 may include the       
resolution of disputes for multiple     
items or services1 if such determination
 is in regard to items or services that 
are eligible for independent dispute    
resolution under subsection 7c77#b74    
7,d7 ,factors ,in determining which     
final offer to select as the more       
reasonable amount under subparagraph    
7,a71 the independent dispute resolution
 entity shall consider relevant factors 
including-- 7i7 commercially reasonable 
rates for comparable services or items  
in the same geographic area 7which shall
 take into consideration in-network     

rates for that geographic area and not  
charges72 and  7ii7 other factors that  
may be submitted at the discretion of   
either party1 which may include-- 7,i7  
the level of training1 education1       
experience1 and quality and outcomes    
measurements of the out-of-network      
health care provider2  7,,ii7 the       
circumstances and complexity of the     
particular dispute1 including the time  
and place of the service2  7,,iii7 the  
market share held by the out-of-network 
health care provider or that of the plan
 or issuer2  7,,iv7 demonstration of    
good faith efforts 7or lack of good     
faith efforts7 made by the              
out-of-network provider or the plan to  
contract and prior negotiated rates1 if 
applicable2 and  7,v7 other relevant    
economic aspects of provider            
reimbursement for the same specialty    
within the same geographic area4  7,e7  
,effect of determination ,a final       
determination of an independent dispute 
resolution entity under subparagraph    

7,b7-- 7i7 shall be binding2 and  7ii7  
shall not be subject to judicial review1
 except in cases comparable to those    
described in section #aj7;a7 of title   
#i1 ,united ,states ,code1 as determined
 by the ,secretary in consultation with 
the ,secretary of ,labor1 and cases in  
which information submitted by one party
 was determined to be fraudulent4  7#d7 
,privacy laws ,an independent dispute   
resolution entity shall1 in conducting  
an independent dispute resolution       
process under this subsection1 comply   
with all applicable ,federal and ,state 
privacy laws4  7#e7 ,public availability
 ,the reasonable amount determined by an
 independent dispute resolution entity  
under this subsection with respect to   
any claim shall not be confidential1    
except that information submitted to the
 independent dispute entity shall be    
kept confidential4 ,independent dispute 
entities may consider past decisions    
awarded by independent dispute entities 
during the independent dispute          

resolution process4  7#f7 ,costs of     
independent dispute resolution process  
,the nonprevailing party shall be       
responsible for paying all fees charged 
by the independent dispute resolution   
entity4 ,if the parties reach a         
settlement prior to completion of the   
independent dispute resolution process1 
the costs of the independent dispute    
resolution process shall be divided     
equally between the parties4  7#g7      
,payment ,group health plans and health 
insurance issuers with respect to group 
health coverage shall pay directly to   
the health care provider amounts        
determined by the independent dispute   
resolution entity within #cj days of the
 date on which the entity makes a       
determination with respect to such      
amount4 ,a plan or issuer that fails to 
comply with this paragraph shall be     
subject to the penalties described in   
section #bgbi;,a7c77#c74  4  7b7        
,emergency services ,section            
#bgai;,a7b77#a77;,c77ii77,,ii7 of the   

,public ,health ,service ,act 7#db      
,u4,s4,c4                               
#cjj;gg-#ai;a7b77#a77;,c77ii77,,ii77 is 
amended by inserting 1 deductible       
amount1 after copayment amount4  #d4    
,notification of new insurance products 
to in-network providers ,subpart ,,ii of
 part ,a of title ,,xxvii of the ,public
 ,health ,service ,act 7#db ,u4,s4,c4   
#cjj;gg et seq471 as amended by section 
#c1 is further amended by adding at the 
end the following3  #bgbi;,c4           
,notification of new insurance products 
to in-network providers ,if a health    
care provider has a contract to provide 
in-network services to enrollees in a   
group health plan or health insurance   
coverage offered by a health insurance  
issuer1 the plan or issuer shall notify 
the in-network provider within #g days  
of offering any new insurance product   
for which the in-network provider would 
be eligible to enroll as an in-network  
provider4  4  #e4 ,transparency         
regarding in-network and out-of-network 

deductibles ,subpart ,,ii of part ,a of 
title ,,xxvii of the ,public ,health    
,service ,act 7#db ,u4,s4,c4 #cjj;gg et 
seq471 as amended by section #d1 is     
further amended by adding at the end the
 following3  #bgbi;,d4 ,transparency    
regarding in-network and out-of-network 
deductibles  7a7 ,in general ,a group   
health plan or a health insurance issuer
 offering group or individual health    
insurance coverage and providing or     
covering any benefit with respect to    
items or services shall include1 in     
clear writing1 on any plan or insurance 
identification card issued to enrollees 
in the plan or coverage the amount of   
the in-network and out-of-network       
deductibles and the out-of-pocket       
maximum limitation that apply to such   
plan or coverage4  7b7 ,guidance ,the   
,secretary1 in consultation with the    
,secretary of ,labor1 shall issue       
guidance to implement subsection 7a74  4
  #f4 ,ensuring enrollee access to      
cost-sharing information  7a7 ,in       

general ,subpart ,,ii of part ,a of     
title ,,xxvii of the ,public ,health    
,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa
 et seq471 as amended by section #e1 is 
further amended by adding at the end the
 following3  #bgbi;,e4 ,provision of    
cost-sharing information  7a7           
,cost-,sharing disclosure for medical   
services  7#a7 ,provider disclosures ,a 
group health plan or a health insurance 
issuer offering group or individual     
health insurance coverage shall not     
contract with a health care provider    
with respect to the plan or coverage    
unless the provider agrees to provide an
 enrollee in the plan or coverage1 at   
the time of scheduling an elective      
health care service1 or not later than  
#dh hours of the enrollee requesting    
such information1 the expected enrollee 
cost-sharing for the provision of a     
particular health care service involved 
7including any service that is          
reasonably expected to be provided in   
conjunction with such specific service1 

such as expected cost-sharing of        
laboratory services74  7#b7 ,insurer    
disclosures ,a group health plan or a   
health insurance issuer offering group  
or individual health insurance coverage 
shall provide an enrollee in the plan or
 coverage with a good faith estimate of 
the enrollee's cost-sharing 7including  
deductibles1 copayments1 and            
coinsurance7 for which the enrollee     
would be responsible for paying with    
respect to a specific elective health   
care service 7including any service that
 is reasonably expected to be provided  
in conjunction with such specific       
service such as expected cost-sharing of
 laboratory services71 not later than   
#dh hours after receiving a request for 
such information by an enrollee4  7b7   
,electronically available price         
information ,a group health plan or a   
health insurance issuer offering group  
or individual health insurance coverage 
shall provide to enrollees the          
out-of-pocket costs and benefits        

information at all sites of care and for
 all providers included in the plan     
network4 ,such information shall be made
 available to enrollees through an      
internet website or an application4     
,information about the availability of  
such price information through such     
means shall be provided to each enrollee
 upon enrollment1 or renewal1 in the    
health plan or health insurance         
coverage4  4  7b7 ,effective dates  7#a7
 ,cost-sharing disclosures ,subsection  
7a77#a7 of section #bgbi;,e of the      
,public ,health ,service ,act1 as added 
by subsection 7a71 shall apply with     
respect to plan years beginning on or   
after ,january #a1 #bjbj4  7#b7         
,availability of information ,subsection
 7b7 of section #bgbi;,e of the ,public 
,health ,service ,act1 as added by      
subsection 7a71 shall apply with respect
 to plan years beginning on or after    
,january #a1 #bjba4  #g4 ,medical loss  
ratio ,section #bgah7;a77#a7 of the     
,public ,health ,service ,act 7#db      

,u4,s4,c4 #cjj;gg-#ah7;a77#a77 is       
amended by inserting before the period  
the following3 7including1 in the case  
of group health plans1 the amount of    
independent dispute process expenses    
incurred by the plan74  #h4             
,transparency requirements on hospitals 
,section #bgah of the ,public ,health   
,service ,act 7#db ,u4,s4,c4            
#cjj;gg-#ah7 is amended by adding at the
 end the following3  7f7 ,transparency  
requirements on hospitals  7#a7         
,requirements for hospitals and         
physician groups ,each hospital         
operating within the ,united ,states    
shall for each year disclose on its     
internet website and in printed         
materials1 any financial relationship or
 profit-sharing agreement the hospital  
maintains with a physician group4  7#b7 
,required information  7,a7 ,in general 
,each hospital operating within the     
,united ,states shall include ancillary 
services provided by individuals such as
 phlebotomists1 laboratory technicians1 

and echocardiogram technicians within   
each hospital bill that is provided to  
patients4  7,b7 ,study ,not later than  
#a year after the date of enactment of  
this ,act1 the ,secretary shall conduct 
a study on the feasibility of hospitals 
and hospital-based provider groups      
providing to patients a single1 unified 
bill for all services provided within an
 episode of care4  4  #i4 ,transparency 
requirements on insurance  7a7 ,group   
health plan reporting ,part ,c of title 
,,xxvii of the ,public ,health ,service 
,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq47
 is amended by adding at the end the    
following3  #bgie4 ,transparency        
requirements for group health plans  7a7
 ,in general ,each group health plan and
 health insurance issuer offering group 
or individual health insurance coverage 
shall annually report to the ,secretary 
of ,health and ,human ,services and the 
,secretary of ,labor1 with respect to   
the applicable plan or coverage for the 
applicable plan year--  7#a7 the total  

claims that were submitted by in-network
 health care providers with respect to  
enrollees under the plan or coverage1   
and the number of such claims that were 
paid and the number of such claims that 
were denied2  7#b7 the total claims that
 were submitted by out-of-network health
 care providers with respect to         
enrollees under the plan or coverage1   
and the number of such claims that were 
paid and the number of such claims that 
were denied2  7#c7 with respect to each 
out-of-network claim1 the out-of-pocket 
costs1 including applicable cost-sharing
 amounts1 to the enrollee for the       
services1 and the difference between the
 billed charge and the amount the plan  
pays1 adjusted by any balance billing   
limitation through ,state and ,federal  
regulatory and statutory requirements   
that might apply2  7#d7 the number of   
out-of-network claims reported under    
paragraph 7#b7 that are for emergency   
services2 and  7#e7 the number of       
out-of-network claims reported under    

paragraph 7#b7 that relate to care at   
in-network hospitals or facilities      
provided by out-of-network providers4   
7b7 ,clarification ,the information     
required to be submitted under this     
section shall be in addition to the     
information required to be submitted    
under section #bgae;,a4  4  #aj4        
,applicability to ,states with surprise 
billing laws  7a7 ,general application  
7#a7 ,in general ,nothing in this ,act1 
or the amendments made by this ,act1    
shall be construed to prohibit a ,state 
from enacting patient protections that  
are greater than those provided for in  
such amendments4  7#b7 ,application to  
all plans ,in the case of a group health
 plan1 individual health plan1 and      
non-,federal governmental health plan   
offered in a ,state that has not enacted
 a law to determine the payment         
resolution between enrollees and health 
care facilities or professionals        
relating to surprise medical bills1 the 
procedures applicable to self-insured   

group health plans for the resolution of
 surprise medical bills under this ,act 
7including the amendments made by this  
,act71 shall apply to determine         
compensation with respect to a surprise 
medical bill1 until such time as the    
,state enacts a law providing for such a
 resolution methodology4  7b7           
,provisions applicable to ,,erisa       
,section #gae of the ,employee          
,retirement ,income ,security ,act of   
#aigd 7#bi ,u4,s4,c4 #aahe;d7 is amended
 by adding at the end the following3    
7c7 ,prohibitions on balance billing    
7#a7 ,fully insured plans ,in the case  
of a fully insured group health plan--  
7,a7 a ,state may establish procedures  
for determining the appropriate         
compensation applicable to surprise     
medical bills between a participant or  
beneficiary and a health care facility  
or professional so long as the          
methodology used relies on the          
definition of surprise medical bill and 
the prohibitions contained in section   

#bgbi;,a of the ,public ,health ,service
 ,act2 and  7,b7 a ,state may enact laws
 relating to rate-setting1 independent  
dispute resolution1 an in-network       
guarantee1 or an alternative methodology
 that complies with paragraph 7#a74     
7#b7 ,self-insured plans ,in the case of
 a self-insured group health plan1 the  
resolution methodology provided for     
under section #bgbi;,a of the ,public   
,health ,service ,act1 shall be used to 
determine compensation with respect to a
 surprise medical bill4  4  7c7 ,,fehbp 
,in the case of a health plan under     
chapter #hi of title #e1 ,united ,states
 ,code1 the resolution methodology      
provided for under this ,act 7including 
the amendments made by this ,act71 shall
 be used to determine compensation with 
respect to a surprise medical bill4     
#aa4 ,balance billing study  7a7 ,in    
general ,not later than #c years after  
the date of enactment of this ,act1 the 
,secretary of ,health and ,human        
,services1 in consultation with the     

,secretary of ,labor1 shall conduct a   
study of the effects of this ,act       
7including the amendments made by this  
,act71 and submit to ,congress a report 
on the findings of such study1 which    
shall include information and analysis  
on-- 7#a7 the financial impact on       
patient responsibility for health care  
spending and overall health care        
spending2  7#b7 the incidence and       
prevalence of the delivery of           
out-of-network health care services2    
7#c7 the adequacy of provider networks  
offered by health plans and health      
insurance issuers 7as such terms are    
defined in section #bgia of the ,public 
,health ,service ,act 7#db ,u4,s4,c4    
#cjj;gg-#ia772  7#d7 the impact of      
connecting reimbursement to different   
claims databases2  7#e7 the number of   
bills that go to the independent dispute
 resolution process2 and  7#f7 the      
administrative cost of the independent  
dispute resolution process and estimated
 impact on health insurance premiums and

 deductibles4  7b7 ,information         
requirements ,the information provided  
in the report under subsection 7a7 shall
 be--  7#a7 disaggregated by ,state and 
according to the fully insured and the  
self-insured markets2 and  7#b7 with    
respect to paragraphs 7#a7 through 7#c7 
of such subsection1 made available to   
the public electronically in a          
searchable database4