HOUSTON December 12, 2019 - “This plan will be bad for our patients and bad for the physicians and hospitals that care for them – but definitely good for Big Insurance.”
TMA has been fighting hard this year to ensure that legislation on unexpected out-of-network medical bills follows this prescription:
- Take patients “out of the middle” of out-of-network surprise billing disputes between insurance companies and physicians, hospitals, and providers.
- Require a fair initial payment from the insurance company to the physician or provider before the beginning of any dispute resolution process. If the physician or provider is unhappy with the payment, he or she should be able to turn to a dispute resolution process.
- Use an independent dispute resolution process (after the initial payment) that does not give an unfair advantage to either side.
- Use a benchmark identified by market forces via an independent, not-for-profit database to determine fair compensation for surprise out-of-network bills.
- Base final payment amount on clear factors, including the complexity of the case and the experience of the physician.
- Incentivize health insurance companies to offer measurably adequate networks of physicians, hospitals, and providers.
“We will continue to work with Congress and our colleagues around the country to make sure that Washington gets this right,” Dr. Fleeger said.
Congress this year has been considering several competing measures that would take the patient out of the middle of haggling between physicians and insurers over out-of-network bills.
One version making its way through Congress – HR 3630, the No Surprises Act by Reps. Frank Pallone (D-N.J.) and Greg Walden (R-Ore.) – is similar to the compromise that those two congressmen and Sen. Lamar Alexander (R-Tenn.) announced this weekend.
TMA, the American Medical Association (AMA), and much of organized medicine have backed a different approach: the Protecting People from Surprise Medical Bills Act, sponsored by Reps. Raul Ruiz (D-Calif.) and Phil Roe, MD (R-Tenn.).