A 2020 law intended to protect patients from “surprise” medical bills would get an overhaul under a bill introduced Thursday by Rep. Frank Pallone Jr., ranking member of the House Energy and Commerce Committee.

The New Jersey Democrat’s bill would replace the law’s arbitration process that insurers and providers use to reach a decision on payment for some out-of-network services, like emergency department visits. Instead, the fee would be calculated based on a median rate insurers pay for in-network services.

“Today, I’m pleased to say patients no longer receive these outrageous bills, but unfortunately the arbitration process is clearly not working,” Pallone said in a statement Thursday. “A few bad actors — largely backed by private equity — are gaming the system, creating backlogs, delaying payments, and driving up premiums.”

Dubbed the No Surprises Act, the bill aims to shield patients from huge bills when they received care from out-of-network providers, whether at emergency rooms, in-network hospitals or other medical facilities.

The law created a “baseball-style” arbitration process that providers and health plans could use to reach an agreement on payment when there is no pre-negotiated contract between the parties.

While having parties go to arbitration was supposed to be a rare phenomenon, in many cases it’s now the default — and providers generally win, receiving payouts averaging over six times the local in-network rates.

Providers have secured an additional $15 billion in arbitration payments in 2025 alone.

Health policy analysts have found that the arbitration payouts are contributing to higher premiums for both employers and employees.

Pallone’s bill would replace the arbitration process with a payment system based on the median in-network rate. It would also require payments be issued within 30 days of the claim being filed.

That’s the type of system insurers and some members of Congress, including Pallone, advocated for when lawmakers were drafting the 2020 law. But providers pushed back hard on the idea of using median in-network rates to determine their payments, arguing it would give insurers too much leverage.

The Ways and Means Committee, at the time led by Rep. Richard E. Neal, D-Mass., favored the arbitration process. Neal has criticized the implementation of the arbitration process.

Action on the bill is unlikely this year, with only a few legislative weeks in the upcoming lame-duck session. If Democrats win control of the House, however, Pallone could be setting the legislative agenda for the Energy and Commerce Committee in the next Congress.