Dear Chairman Neal, Ranking Member Brady, Chairman Scott, and Ranking Member Foxx:
The undersigned organizations are committed to our shared goal of protecting the patients we serve from
surprise medical bills, and keeping them out of the middle of any billing disputes that might arise between
insurers and physicians. As your Committees develop a legislative solution to protect patients from
surprise medical bills, we urge you to keep in mind the potential for unintended consequences of
congressional action to impact patient access to care, particularly in rural and underserved communities.
In order to minimize such consequences, we urge you to include the following policy considerations in
your legislative proposals.
Limits are placed on patient responsibility. Patients should be protected from surprise medical bills when
they unknowingly receive services from out-of-network providers in in-network facilities, and should be
out of any payment disputes between physicians and insurers that can arise. In such situations, patients
should only be responsible for in-network cost-sharing, with balance billing prohibited. Such cost-sharing
protection should apply to copays, coinsurance, and deductibles.
Rate-setting is avoided. A payment process for out-of-network care needs to be established that is keyed
to the market value of physician services and that maintains a level-playing field for future in-network
contract negotiations. A benchmarked rate would provide insurers with access to a discounted contract
rate without providing physicians with the corresponding benefits of contracting in exchange. It then
further erodes the value of the insurance coverage that policyholders have purchased by allowing insurers
to shift even more costs to them in the form of higher deductibles and other cost-sharing. As physicians,
we believe our patients benefit most when we are in network with as many insurers as possible.
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