CAP Objects to Latest Surprise Billing Agreement

The legislative proposal fails to eliminate rate-setting provision and arbitrary threshold for independent dispute resolution.

WASHINGTON--(BUSINESS WIRE)--The College of American Pathologists (CAP) cannot support a recent legislative agreement struck by congressional leaders that relies on insurance industry-controlled rates to pay for unexpected out-of-network services.

Despite repeated calls for changes to the physician payment mechanism for out-of-network services, the legislative plan agreed to by Sen. Lamar Alexander (R-TN) and Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR) still uses rate setting for out-of-network services. The CAP maintains that benchmark payment rates based on median or mean in-network contract rates are unacceptable.

In addition, the legislative agreement includes an arbitrary threshold to access an independent dispute resolution process. Independent arbitration systems work by financially protecting patients and reducing out-of-network costs. The threshold must be removed so all physicians can access a fair and equitable arbitration process.

The CAP also asks Congress to require network adequacy standards for health insurers as part of the holistic solution to address the problem of surprise billing. Read the CAP’s issue brief to learn more about our priorities on surprise medical bills.

About the College of American Pathologists

As the world's largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, visit to watch pathologists at work and see the stories of the patients who trust them with their care. Read the 2018 CAP Annual Report at CAP.ORG.


Contact: Apoorva Stull