12th hour negotiations are taking place in Congress to get Surprise Billing legislation passed before the end of the year. The Medical Association has been engaged on this issue since the beginning of the year advocating for a fair independent dispute resolution process to resolve out of network payment disputes. However the insurance industry has been pushing to set a benchmark for out of network payments to physicians at or below Medicare rates.
Several bi-partisan proposals on the subject have been introduced and are working their way thru the legislative process. Legislation by Sens. Lamar Alexander (R –Tenn) and Patty Murry (D-Wash) has been approved by the Senate Health and Labor Committee and a bill by Reps. Frank Pallone (d-NJ) and Greg Walden (R-Ore) has been approved by the House Energy and Commerce Committee.
The House Ways and Means Committee and the House Education and Labor committees are expected to begin their work on the legislation once Congress returns to Washington. Differences in the competing versions of the legislation exist and mainly surround the issue of how to calculate insurance payments to out of network physicians and hospitals that prevent patients from being stuck with high medical bills.
The Medical Association of the State of Alabama, the AMA, and most national physician specialty organizations are supporting an Independent Dispute Resolution (IDR) as a fair and transparent method of determining the appropriate reimbursement without burdening the patient.
The health insurance industry is pushing back on that approach and supporting a proposal that would set out of network rates at the median in-network rate. Under this method, health insurance companies and the federal government would be setting reimbursement rates for both in-network providers and out of network providers which is a flawed approach and should be opposed.
The Medical Association has sent out several alerts in previous weeks to the membership encouraging physicians to contact Congress in support of the IDR solution. We continue to encourage physicians to make those contacts through our Advocacy Portal.
The Medical Association has also partnered with the Alabama State Society of Anesthesiology to author an op-ed piece that can be found here.