December 10, 2019
Area(s) of Interest: Out of Network Billing
California Medical Association (CMA) President Peter N. Bretan, M.D., issued the following statement on the Senate HELP and House E&C Committee surprise billing proposal:
“CMA physicians agree it’s time to end surprise medical billing, but Congress should not repeat the mistakes made in California that have given insurers the power to game the system, drop physicians from their networks and make it harder to have on-call specialists in emergency rooms. CMA looks forward to working with Congress to find a comprehensive solution that does not disrupt patient care.”
The HELP/E&C Committee fee schedule is similar to a 2016 California law that has given undue leverage to the insurance companies to cancel physician contracts. The proposal will also increase health care costs by accelerating consolidation of physician practices with larger systems, as we have seen in California. It would be a grave error to impose the California policy mistakes on a national level.
CMA supports the inclusion of arbitration as a means to resolve disputes between physicians and insurance companies but remains concerned that the $750 arbitration threshold in this new proposal creates a barrier to fair resolution for physicians whose claims are much less.
Any solution to surprise billing will have a substantial impact on the entire health care system. We urge Congress not to rush a bad policy on such an important issue to meet a false deadline.
CMA believes that Congress should keep working to find the right solution. We continue to urge the following:
- Protect patients from surprise bills
- Allow insurers to determine a reasonable initial payment for out-of-network care
- Establish baseball arbitration to resolve disputes
- Instead of setting an arbitrary threshold to take cases to arbitration, allow physicians to batch claims together to lower the number of arbitrations
- Establish fair payment criteria in arbitration that includes commercially reasonable rates and prior contracting history which is based on existing rates and would not trigger a cost.
- Require insurers to have adequate physician networks to meet patients’ medical needs