THE ISSUE:
Unanticipated medical bills create intense stress for patients. Over half of Americans have been subject to a ‘surprise’ bill or ‘balance’ bill after medical care, according to research from the University of Chicago. Surprise bills are increasing patient
out-of-pocket costs as well as damaging the patient-physician relationship. Unexpected bills for patients are often caused by narrow networks of contracted physicians, hospitals, pharmacies, and other providers. Even when a patient attempts to seek
only in-network care, they can receive unexpected medical bills when an out-of-network provider is involved in their care without their knowledge. Physicians are unable to foresee these situations, because they may not always know the contract status
of every provider involved an individual’s care.
OUR STANCE:
The Massachusetts Medical Society is committed to addressing the problem of surprise bills and their impact on patients. Patients should be held harmless from surprise bills, and they should not be saddled with unfair bills due to unavoidable out-of-network
care. MMS supports a full ban on balance billing for these unexpected out of network bills as part of a comprehensive legislative solution. Effective legislation to address this issue must strike balance to ensure a health marketplace that encourages
contracting between physicians and insurers.
The MMS supports:
- Banning surprise/balance billing practices
- Holding the patient harmless for surprise bills
- Protecting patients from negotiations or additional payments in surprise billing circumstances
- Prudent layperson standards for all plans, including ERISA plans
- Fair notice of coverage or lack of coverage for patients
- Protection for a patient’s freedom to choose a physician and health care delivery system, in order to preserve the patient-physician relationship
- Reasonable reimbursement between the health insurer and the clinician for the services provided
- Billing and collection policies that are reasonable and don’t conflict with applicable state and federal laws or the physician’s ethical duties to patients
- A transparent process that includes opportunity for an appeal to protect physicians from punitive consequences for patient referrals out of network
- Policy specifying that codes for outpatient evaluation and management services, including initial and established patient office visits, be exempt from deductible payments (so insurers will pay the entire usual fee for these codes without triggering
any deductible payment by the patient)
- Evaluation of value-based cost sharing measures for high-deductible health plans and patients’ out-of-pocket costs
- Assessment of the impact of cost-sharing on access to care, health outcomes, and medical debt for patients
- Periodic review of billing and collection policies and their effect on patients
- Legislative proposals should not use the Medicare fee as the default out-of-network physician reimbursement, as it disproportionately underpays certain specialties. A default rate below market value will remove incentives for insurers to negotiate
with physicians.
CURRENT ADVOCACY:
State:
- The MMS supports current House bill 932 as a comprehensive solution to the problem of surprise billing. MMS opposes Senate bill 607, as it does not fairly account for physician compensation. Testimony is posted here on both bills.
Federal:
Sources:
http://www.norc.org/NewsEventsPublications/PressReleases/Pages/new-survey-reveals-57-percent-of-americans-have-been-surprised-by-a-medical-bill.aspx
