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Sen Alexander introduced legislation to curb balance billing, out-of-network billing, or frequently reported in the news media as "surprise billing."
Let me be clear: there is no surprise about it. Many insurance companies purposefully don't contract with physicians because it is a way to avoid paying physicians, hospitals, and other healthcare entities that are out-of-network. By limiting their networks, insurers can force individuals to pay more out-of-pocket expenses when they choose to go to an out-of-network physician or hospital.
The frequency of in-network hospitals having out-of-network physicians occurs in <20% of all in-network hospital visits. Insurers love to spin this because it supports their shift of physicians being to blame.
Alexander's bill would cap out-of-network reimbursement to the typical negotiated in-network rate for the region. While this is better than tying out-of-network physician reimbursement to 125% of the Medicare rate, this will still create problems. As insurers drive physicians to take lower rates, it will further decrease typical contracted rates and physician reimbursement.
This legislation will require physicians to bill promptly. Patients who are sent a bill >45 days after treatment is rendered will NOT be responsible for paying the bill. If the USPS loses the bill, then it cannot be resent. There is nothing that would suggest a patient could simply throw it in the trash and claim to have never received it. Healthcare entities will need tracking to ensure delivery of bills to keep this from happening.
This legislation will also regulate air ambulance services, which have traditionally been viewed as out-of-network.
This legislation is both good and bad. It's better than what is currently in the House Energy and Commerce Committee. It still isn't a fair bill. Write your Representatives and Senators and express your opinion that out-of-network reimbursement be tied to the FAIR Health Database.
If you think that this doesn't affect you and that you don't want to get involved in politics, then you're wrong. Your pay will be directly tied to this. Don't let this sneak up on us. ACEP recently held a legislative update webinar that I hope they can make available for on-demand viewing. It summarizes the problems and hurdles we face with getting fair balance billing legislation passed.
Let me be clear: there is no surprise about it. Many insurance companies purposefully don't contract with physicians because it is a way to avoid paying physicians, hospitals, and other healthcare entities that are out-of-network. By limiting their networks, insurers can force individuals to pay more out-of-pocket expenses when they choose to go to an out-of-network physician or hospital.
The frequency of in-network hospitals having out-of-network physicians occurs in <20% of all in-network hospital visits. Insurers love to spin this because it supports their shift of physicians being to blame.
Alexander's bill would cap out-of-network reimbursement to the typical negotiated in-network rate for the region. While this is better than tying out-of-network physician reimbursement to 125% of the Medicare rate, this will still create problems. As insurers drive physicians to take lower rates, it will further decrease typical contracted rates and physician reimbursement.
This legislation will require physicians to bill promptly. Patients who are sent a bill >45 days after treatment is rendered will NOT be responsible for paying the bill. If the USPS loses the bill, then it cannot be resent. There is nothing that would suggest a patient could simply throw it in the trash and claim to have never received it. Healthcare entities will need tracking to ensure delivery of bills to keep this from happening.
This legislation will also regulate air ambulance services, which have traditionally been viewed as out-of-network.
This legislation is both good and bad. It's better than what is currently in the House Energy and Commerce Committee. It still isn't a fair bill. Write your Representatives and Senators and express your opinion that out-of-network reimbursement be tied to the FAIR Health Database.
If you think that this doesn't affect you and that you don't want to get involved in politics, then you're wrong. Your pay will be directly tied to this. Don't let this sneak up on us. ACEP recently held a legislative update webinar that I hope they can make available for on-demand viewing. It summarizes the problems and hurdles we face with getting fair balance billing legislation passed.
