Congress has spent the better part of this year trying to solve the problem of unexpected medical bills for out-of-network (OoN) care. AAOS-supported legislation achieved an important milestone in mid-October when it surpassed 100 cosponsors in the House of Representatives. The bill, called the Protecting People from Surprise Medical Bills Act (H.R. 3502), closely mirrors the successful model that is in place in the state of New York and has received wide support from the physician community.
“AAOS applauds Representatives Raul Ruiz, MD (D-Calif.), Phil Roe, MD (R-Tenn.), and others for drafting a proposal that protects patients from these ‘surprise bills,’ while preserving a fair playing field for resolving disputes,” said AAOS President Kristy L. Weber, MD, FAAOS, when the concept for the bill was first introduced. “By removing patients from the middle and allowing for ‘baseball-style’ arbitration, the Protecting People from Surprise Medical Bills Act incentivizes insurers and [healthcare professionals] to come to the table and negotiate a fair rate.”
The legislation proposes having an arbiter consider a multitude of factors when deciding a final price, including a fair and independent database of charges, the complexity of the case, specialization of the physician, and more. In the state of New York, the process has reduced complaints related to surprise bills, increased the number of in-network physicians, and saved healthcare dollars.
As of mid-October, the bill had more cosponsors than any other pending legislation on surprise medical billing in the House of Representatives. AAOS joined the Out of The Middle Coalition, composed of leading healthcare professional groups, in celebrating this achievement and applauding members of Congress for their leadership on this important patient-protection issue.
“Reaching this cosponsorship milestone, the Protecting People from Surprise Medical Bills Act, demonstrates the widespread and growing interest in advancing a balanced solution to the surprise medical billing problem,” the Coalition wrote in a statement of support. It continued by noting that the bill gets to the root cause of the issue—inadequate insurance networks.
Specifically, the legislation …
- includes robust patient protections that ensure individuals only pay in-network amounts for their care, whether the care provided was in network or OoN
- makes it easier for patients to understand the limits of their insurance coverage, safeguards access to emergency care, and preserves access to planned care by the physicians of their choice
- encourages transparency from health plans and establishes a fair and efficient process for payment dispute resolution between physicians and insurers, with no patient involvement
The momentum of this proposal and backing by members of Congress demonstrate that advocacy efforts are making an impact (see infographic). But the fight for patient protection continues. As key committees review proposals and get closer to making a decision later this year, physicians nationwide must continue to make their voices heard.
“We strongly encourage key committees tasked with addressing this issue, including the House Committee on Education and Labor and the House Committee on Ways and Means, to consider this particular legislation as the most equitable and common-sense solution to tackle surprise medical bills,” the Coalition concluded.
Learn more about the issue of surprise billing and get involved with AAOS advocacy efforts today at www.aaos.org/surprisebilling.