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Congress Works to Address Surprise Medical Billing

Summary

Over the past several months, a bipartisan effort has emerged in Congress to address the growing problem of surprise medical billing where patients are saddled with unanticipated, high out-of-pocket costs for out-of-network services in both emergency and nonemergency settings. The President also issued an executive order in June requiring transparency of health care costs that calls for expanding access to health care data, as well as regulatory steps to address surprise billing. This issue has likewise received a great deal of attention in the media and nearly all of organized medicine sees this issue as an important issue.  State medical societies may be contacting ACP chapters to ask for their advocacy engagement on this issue so ACP would like chapters to be adequately informed about ACP’s principles on surprise medical billing, what advocacy we are doing on the national level, and provide chapters with resources on this issue should they wish to engage in advocacy efforts.

Background

The House Energy and Commerce, Ways and Means, Education and Labor as well as the Senate HELP Committee are all examining this issue and are working to develop legislation to address the issue.  Several legislative proposals, with differing elements, have already been put forth and are working their way through the committee process.  ACP has weighed in with the committees on the various individual proposals and, most recently, submitted a set of key principles that it recommends any final legislative product include. ACP’s guiding policy on surprise medical bills is outlined in its position paper entitled, “Improving Health Care Efficacy and Efficiency Through Increased Transparency.”

Key ACP Principles

Hold Patients Harmless: Provide protections for patients from unexpected out-of-network health care costs, particularly for costs incurred during an emergency situation or medical situation in which additional services are provided by out-of-network clinicians without the patient’s prior knowledge.

Ensure Network Adequacy: How network adequacy and the fair payment of services for physicians may contribute to the increase in patients receiving out-of-network care should also be examined by Congress to ensure an appropriate number of available in-network physicians, especially in the emergency setting. Health plans also have an affirmative obligation to pay fairly and appropriately for services provided in- and out-of-network, and regulators should ensure network adequacy in all fields, including emergency care.

Opt for Fair Arbitration of Payment Instead of Set In-Network Rate: Caps on payment for physicians treating out-of-network patients should be avoided, preferably by establishing an arbitration process that would allow an independent arbitrator to establish an appropriate and fair payment level between the insurers’ in-network rate and the clinician’s charge. 

Should chapters be asked to engage with their state medical societies or sign on to letters in support of congressional efforts to address surprise medical bills, we have developed a set of talking points to accompany our key principles so that chapters can ensure their advocacy efforts are consistent with ACP policy.  

Resources