September 11, 2019
Area(s) of Interest: Advocacy Out of Network Billing
Congress has taken significant steps in moving legislation aimed at tackling the issue of surprise billing by passing bills out of committees in both the House and Senate. Federal legislation would ban balance billing for federally-regulated self-insured ERISA plans. This would impact more than 40% of California’s insurance market.
Both bills would protect patients by limiting their out-of-pocket costs to amounts they would have owed if they had been treated by an in-network physician. And the California Medical Association (CMA) agrees patients should be protected from surprise medical bills. However, neither bill holds health insurers accountable.
Both bills would resolve payment disputes between physicians and insurers by setting out-of-network payments at the median amount each insurer pays for in-network care. However, neither bill includes a fair process that incentivizes insurers to contract at reasonable rates.
Congress is currently modeling this federal legislation on California’s surprise billing law (AB 72). While California has succeeded in protecting patients from surprise medical bills, the rest of the law is not working.
California payors are asserting, however, that their physician networks are larger than ever since the passage of California’s surprise billing law.
This is why CMA, the American Medical Association, and our partner specialty societies are asking physicians take a short survey to share feedback on the impact that California’s laws are having on practice viability, patient access to in-network physician care, as well as emergency and on-call medical services. We need to hear your story.
Take the survey now at: https://www.surveymonkey.com/r/surprisebillingimpact
The results of this survey will be crucial in helping CMA and our partners effectively advocate for a fair and balanced process for physicians to resolve contracting and payment disputes with payors. Please share your experience by responding to our brief (5-7 minute) survey. It is critical that we receive your response no later than Wednesday, September 18, 2019.