October 26, 2021
Area(s) of Interest: Out of Network Billing
As recently reported, the California Medical Association (CMA) is deeply concerned with the second regulation released by the Biden Administration on surprise billing, and we have a new way for you to help us fight back.
The second regulation, which sets forth how the critical independent dispute resolution (IDR) process will be implemented, is completely out of step with the final legislation, the No Surprises Act, that Congress voted on and passed last December. As intentionally designed by Congress, the IDR process was to offer a balanced interaction between insurance companies and physicians once patients are out of the middle of billing disputes.
But instead, the new rule undermines the entire IDR process by requiring arbiters to greatly prioritize the artificially low median in-network rate, set by insurance companies, rather than considering all factors in the set forth in the statute as passed by Congress.
This approach is sure to drive payment rates lower and encourage insurance companies to narrow their networks even further, which would make it harder for patients to get medical care. We now fear the viability of physician practices is at stake, and it will be harder for physicians to care for patients, particularly in small or rural communities. The administration’s interpretation of the legislation is far outside the bounds of what Congress passed into law with its No Surprises Act.
Rep. Tom Suozzi (D-NY), Rep. Brad Wenstrup (R-OH), and Rep. Raul Ruiz (D-CA) are circulating a letter addressed to Health and Human Services Secretary Becerra, Labor Secretary Walsh, and Treasury Secretary Yellen, urging their respective departments to follow the letter of the law and amend the rule to align the law's implementation with the legislation that Congress passed.
We need your help to urge legislators in the House of Representatives to sign on to this letter. A strong showing of bipartisan concern is critical to bring the Administration's attention to the overreach and gross misinterpretation of the IDR section of this law and to compel their action to amend it to align with congressional intent.
Please contact your member of Congress immediately, as the deadline to sign on to the letter is Friday, October 29, 2021.