December 16, 2019
Area(s) of Interest: Advocacy AB 72 Out of Network Billing
With only two weeks before Congress adjourns for the year, Congressional committees introduced competing proposals to address surprise medical bills before the end of the year. Last week, the Senate Health, Education, Labor and Pension (HELP) Committee and the House Energy and Commerce (E&C) Committee announced an agreement that would protect patients from surprise bills but would pay physicians a benchmark payment rate of median in-network rates. The agreement also sets a $750 single-claim threshold to access a baseball arbitration process.
Because it is based on the failed California law (AB 72) the California Medical Association (CMA) announced its opposition to this agreement. CMA is urging physicians to contact their Members of Congress TODAY and tell them the new surprise billing proposal is bad for patients and physicians.
Under this proposal, the benchmark payment rate would become the de facto payment rate for all physicians, regardless of their network status. While CMA supports the inclusion of arbitration as a means to resolve disputes between physicians and insurance companies, the $750 arbitration threshold creates a barrier to fair resolution for physicians if their claims do not meet that threshold.
In the long-term, this proposal will reduce patient access to in-network physicians, and emergency and on-call physician specialists.
On Wednesday, the House Ways and Means Committee entered the deliberations with a bipartisan proposal of their own. They have only released an outline, but it could be an improvement over the Senate HELP/House E&C proposal in that it does not appear to have a benchmark payment rate. However, they need more time to develop their proposal.
CMA and the rest of organized medicine is calling upon Congress to take more time to find a more balanced approach, and get the policy right. 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 is asking physicians to call and write their Members of Congress and urge the following:
- Protect patients from surprise bills.
- Take more time into 2020 to adopt a more balanced solution.
- Oppose the Senate HELP/House E&C Committee agreement. It is based on the failed California law, which gives for-profit insurance companies too much power at the expense of patients and physicians.
- Preserve patient access to physicians. California’s AB 72 is eroding access to care. It would be a grave error to impose the California policy mistakes on a national level.
For more information, see CMA’s Surprise Billing Principles.