Tweet
As you might heave heard, Balance billing or “surprise billing” is quickly being resolved at the federal level. The outcome of the resolution will affect all of us deeply. Multiple committees and representatives/senators have proposed solutions to patients being left with massive out of network bills after emergencies.
Insurance companies have used this urgency to craft legislation that will tie reimbursement for out of network care to either Medicare rates or “median” regional rates. This will effect ALL physician/np/pa reimbursement! In California a bill was passed linking these rates to Medicare as a benchmark. This has led to insurance companies dropping physicians from networks and ceasing all negotiations on rates to accept Medicare rates as the default. Eventually this would lead to all reimbursement at Medicare rates or a percentage add on to the Medicare rate.
Please write an email to your state senator and your representative to encourage them to support the New York model for balance billing (Patient held harmless, independent board to assess regional payments, 80th percentile payment for out-of-network emergency care, baseball style arbitration for disagreements). Here is how you can find them:
https://www.senate.gov/senators/index.htm
https://www.house.gov/representatives/find-your-representative
I have included at the bottom a sample letter and contact information for each of the Senators and Representatives to make it easy.
Dear Sen. or Rep. ,
I am writing to urge you to oppose the surprise medical bill provisions of the “Lower Health Care Costs Act” that was recently introduced by Senators Alexander (R-TN) and Murray (D-WA). The Alexander-Murray provisions are completely unworkable for physicians and threaten health care delivery all over our country. Please revise these provisions to address the concerns of the physician community.
As a physician practicing in , protecting my patients from surprise medical bills is a high priority. In fact, well over 90 percent of our claims are in-network. To address those out of network services, I support holding patients harmless from additional out of pocket costs.
To address billing disputes, I support a fair and independent dispute resolution mechanism — one that balances the interests of providers and insurance companies. As currently written, the Alexander-Murray proposal fundamentally reweights the health care marketplace to the benefit of insurance companies. Physician practices all over the country will suffer. Additionally, insurance companies will have no incentive to create adequate networks of providers. Therefore, the number of patients receiving heath care out of network will only increase. An example of this is seen in California where an out of network bill was linked to Medicare rates and has led to multiple insurance companies dropping physicians from their networks at alarming rates.
Additionally, under this proposal, the federal government would set in law an unprecedented “benchmark” or payment cap in the commercial insurance marketplace. Payments to out of network physicians and other providers would be capped at the “local median contracted commercial amount” – an amount determined by and ultimately controlled by insurance companies. This misguided price setting will undermine my practice. It will also harm my colleagues’ practices in rural areas.
The Senate should instead consider and advance a well-tested, successful model such as that provided by the state of New York, elements of which are included in Senator Cassidy’s and the Bipartisan Work Group’s proposal. New York provides robust patient protections that removes patients from billing disputes, so they are responsible for nothing more than their in-network copays and deductibles. It also creates an independent dispute resolution process to address billing disputes between physicians and insurers, and guides payment to a market-based, reasonable cost. The New York model has been in place since 2015 and studies indicate that it has reduced complaints related to surprise medical bills.
Once again, I urge you to oppose the surprise medical bills provisions in the “Lower Heath Care Costs Act” and to instead support a re-balancing of the proposal.
Sincerely,
Dr.
123 main st any town USA
Insurance companies have used this urgency to craft legislation that will tie reimbursement for out of network care to either Medicare rates or “median” regional rates. This will effect ALL physician/np/pa reimbursement! In California a bill was passed linking these rates to Medicare as a benchmark. This has led to insurance companies dropping physicians from networks and ceasing all negotiations on rates to accept Medicare rates as the default. Eventually this would lead to all reimbursement at Medicare rates or a percentage add on to the Medicare rate.
Please write an email to your state senator and your representative to encourage them to support the New York model for balance billing (Patient held harmless, independent board to assess regional payments, 80th percentile payment for out-of-network emergency care, baseball style arbitration for disagreements). Here is how you can find them:
https://www.senate.gov/senators/index.htm
https://www.house.gov/representatives/find-your-representative
I have included at the bottom a sample letter and contact information for each of the Senators and Representatives to make it easy.
Dear Sen. or Rep. ,
I am writing to urge you to oppose the surprise medical bill provisions of the “Lower Health Care Costs Act” that was recently introduced by Senators Alexander (R-TN) and Murray (D-WA). The Alexander-Murray provisions are completely unworkable for physicians and threaten health care delivery all over our country. Please revise these provisions to address the concerns of the physician community.
As a physician practicing in , protecting my patients from surprise medical bills is a high priority. In fact, well over 90 percent of our claims are in-network. To address those out of network services, I support holding patients harmless from additional out of pocket costs.
To address billing disputes, I support a fair and independent dispute resolution mechanism — one that balances the interests of providers and insurance companies. As currently written, the Alexander-Murray proposal fundamentally reweights the health care marketplace to the benefit of insurance companies. Physician practices all over the country will suffer. Additionally, insurance companies will have no incentive to create adequate networks of providers. Therefore, the number of patients receiving heath care out of network will only increase. An example of this is seen in California where an out of network bill was linked to Medicare rates and has led to multiple insurance companies dropping physicians from their networks at alarming rates.
Additionally, under this proposal, the federal government would set in law an unprecedented “benchmark” or payment cap in the commercial insurance marketplace. Payments to out of network physicians and other providers would be capped at the “local median contracted commercial amount” – an amount determined by and ultimately controlled by insurance companies. This misguided price setting will undermine my practice. It will also harm my colleagues’ practices in rural areas.
The Senate should instead consider and advance a well-tested, successful model such as that provided by the state of New York, elements of which are included in Senator Cassidy’s and the Bipartisan Work Group’s proposal. New York provides robust patient protections that removes patients from billing disputes, so they are responsible for nothing more than their in-network copays and deductibles. It also creates an independent dispute resolution process to address billing disputes between physicians and insurers, and guides payment to a market-based, reasonable cost. The New York model has been in place since 2015 and studies indicate that it has reduced complaints related to surprise medical bills.
Once again, I urge you to oppose the surprise medical bills provisions in the “Lower Heath Care Costs Act” and to instead support a re-balancing of the proposal.
Sincerely,
Dr.
123 main st any town USA
Comment