Rep. Ruiz’s Proposal Creates a Fair Reimbursement System for Out-of-Network Patient Care

  • 23-MAY-2019


Washington — The College of American Pathologists (CAP) issued the following statement following the release of a legislative outline by Rep. Raul Ruiz, MD, to tackle surprise out-of-network medical bills by developing a fair reimbursement system for patient care and alternative dispute resolution process: 

“We are encouraged by the direction put forward in Rep. Ruiz’s legislative outline to address the issue of surprise billing. The solutions as proposed would take necessary steps to accomplish our goals of holding patients financially harmless from surprise medical bills while creating a fair reimbursement system that keeps patients out of the middle of billing disputes. In particular, the CAP is pleased to see inclusion of a baseball-style arbitration process that allows consideration for a range of factors, including the usual and customary rate that reflects the market value of physician services. While we appreciate that the proposal avoids the use of a rate that could be wholly controlled by insurers, key network adequacy provisions to address the root cause of out-of-network bills should be included in the next version of the proposal. 

“The ideas outlined in this proposal represent a commonsense approach that ensures the financial viability of the health care delivery system and preserves patient access to their physicians. We look forward to evaluating the forthcoming legislative language and will continue working with Rep. Ruiz, his colleagues, and other stakeholders to end out-of-network surprise bills for all patients.

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.