Dear Chairman Scott and Ranking Member Foxx,
The medical community remains committed to working with Congress to seek an evenhanded
legislative solution to protect patients from unanticipated (“surprise”) medical bills that can occur
with narrow health insurance networks and when gaps in health insurance coverage lead them
to receive care from out-of-network physicians or other providers, while at the same time
facilitating a process to quickly, efficiently and fairly resolve physician and health plan billing
disputes. As conversations regarding a final compromise solution continue, physicians strongly
believe that the following provisions are essential to any surprise medical billing legislative
solution to ensure patients’ continued access to quality care:
- Protecting Patients. Patients must be protected and should only be responsible for their in-network cost-sharing amounts, including deductibles, when receiving unanticipated medical care.
- Truly Keeping Patients Out-of-the-Middle. To keep patients out-of-the-middle of any payment disputes between health plans and providers, provide physicians with direct payment/assignment of benefits from the insurer. Under proposals currently being considered in Congress, patients will continue to receive confusing bills from multiple providers following a hospitalization.
- Ensuring Reasonable Provider Payment Rates. Following the delivery of out-of-network medical care, a reasonable payment should be paid directly to providers. A benchmark payment rate set at median or mean in-network contract rates or some percentage of Medicare is insufficient because this could increase health care costs by accelerating consolidation in the health care market, jeopardize the emergency care safety net and restrict patient access to in-network physicians.
- Establishing a Fair, Accessible and Equitable IDR Process. If either party determines that the insurer’s payment is not reasonable, there must be a fair, accessible and equitable IDR process to resolve payment disputes.
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