Last week the chair of Senate Health, Education, Labor and Pension (HELP) Committee and the chair and ranking member of the House Energy and Commerce Committee announced an agreement on federal legislation to end surprise medical bills.
The agreement is a merging of surprise billing legislation passed earlier in the year by both committees. While the compromise legislation would protect patients by limiting their out-of-pocket costs to amounts they would have owed if they had been treated in-network, the American Medical Association reports that it also includes potentially devastating provisions that would resolve payment disputes between physicians and insurers by using a benchmark rate setting out-of-network payments at the median amount insurers pay for in-network care.
“By relying on a benchmark rate and a very limited IDR process, this compromise does little but benefit the bottom line for the insurance companies at the expense of patients seeking a robust network of physicians for their care,” the AMA states in an AMA Grassroots Update.
With only a few more working days before the end of the year, Congress still has much to do. The AMA urges all physicians contact your members of Congress to demand that any surprise billing legislation should:
- Improve insurer accountability
- Limit patient financial liability
- Tie out-of-network payments to local market values
- Provide a robust and independent dispute resolution process
- Keep patients out of the middle of insurer-provider payment negotiations
Tell your legislators to keep working to ensure surprise billing legislation includes a robust and independent dispute resolution process that treats all stakeholders equally while protecting access to care!