March 18, 2019
Area(s) of Interest: Advocacy Physician Leadership Payor Issues and Reimbursement Out of Network Billing
A bipartisan group of United States Senators are working to draft legislation to protect patients from unanticipated medical bills. In response to a recent request for information from stakeholders, the California Medical Association (CMA) sent a letter describing the California experience with California’s emergency services balance billing ban and surprise medical bill legislation for non-emergency services.
CMA outlined the numerous problems that California physicians are experiencing with contracting for appropriate rates and accessing the dispute resolution process. CMA is asking Congress to develop a balanced approach by incentivizing insurers to have robust, meaningful networks while assuring patients are protected from out-of-network bills.
CMA is urging Congress to adopt the New York model that protects patients from unanticipated bills, and uses the 80th percentile of billed charges from FAIR Health (an independent database) and baseball arbitration to reimburse physicians. It also requires adequate networks and accurate provider directories.
CMA is also working with California physician Congressman Raul Ruiz, M.D., to introduce legislation that would implement the New York model in California.
For more information, see CMA’s letter to the U.S. Senate on this issue.