Legislation

Legislative Q

Legislative Update

Opposition to Proposal Addressing Surprise Medical Billing

Tennessee Medical Association (TMA), Memphis Medical Society and other physician advocacy groups oppose a “compromise” that Congress announced this week on a bipartisan proposal to “address the issue of surprise medical billing.” TMA said in a recent media release that if the law is signed, it will be disastrous for physicians and patients alike.

“The late addition of an independent review process, consistently espoused by TMA and organized medicine, is marred by other factors such as a $750 threshold, a 90-day ban on arbitration with the same health insurance plan, and insufficient benchmarks consideration for the arbitrator. If the compromise bill passes, health insurance companies will only be required to initially reimburse out-of-network physicians the market-based median in-network negotiated rate.

The biggest sticking point for physicians throughout the negotiations is that Congress could allow insurance companies to effectively set the payment rates for out-of-network services. TMA has worked with the American Medical Association, Physicians Advocacy Institute and national specialty societies to explain to lawmakers how such a measure would incentive health insurance companies to cut their own costs (i.e. increase their own profits) by eliminating providers with highest rates and drive down the median, or average, to as close to zero as possible.”

TMA and special interest groups have advocated to address the issue of surprise medical bills for the past few years. Engaging Tennessee’s congressional delegation, TMA has tried to ensure that federal legislation contains the core principles listed below, which the most recent bill touted by Congressional leaders does not adequately address.

“Hold patients harmless for out-of-network charges without removing Tennessee’s ban on the corporate practice of medicine, prohibiting balance billing or obstructing physicians’ right to be fairly compensated for the services they provide. The compromise keeps patients out of the middle but in no way offers fair compensation for physicians who provide out-ofnetwork services or a level playing field to negotiate reimbursement.

Hold health plans accountable to patients with reasonable network adequacy standards. The compromise fails. There are no measures to hold plans responsible to minimum standards for having enough providers in network to afford patients choice. Do not allow insurance companies to set their own reimbursement rates without negotiating with physicians and other healthcare providers. If plans can drive rates lower, soon all providers will be out of network.

Create a fair arbitration process to resolve payment disputes between providers and payers, and keep the patient out of it. The compromise includes such a measure but neuters it with insurance-friendly provisions.” To protect patients and physicians, TMA, AMA and many other organized medicine groups support “The Protecting People from Surprise Medical Bills Act,” sponsored by Reps. Raul Ruiz (D-Calif.) and Phil Roe, (R-Tenn.).

“TMA urges members to contact their elected officials in the Senate and House of Representatives immediately, and let them know the so-called compromise does not go far enough to protect patients and physicians. Ask them to reject the compromise and instead support H.R. 3502.”

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