Help MAG eliminate surprise bills 

The Medical Association of Georgia (MAG) is encouraging its members and every other Georgian to contact their U.S. representative and U.S. Sens. Johnny Isakson and David Perdue to encourage them to support legislation that will eliminate surprise medical bills.

The U.S. House Energy & Commerce Committee recently passed the ‘No Surprises Act,’ which is designed to “protect patients from unanticipated medical bills for services provided by out-of-network physicians and facilities in emergencies and other situations where they have no opportunity to choose an in-network provider.”

MAG believes that lawmakers are generally headed in the right direction with this legislation, including the addition of an appeals process for physicians and other health care providers to resolve out-of-network payment disputes with insurers.

However, MAG is concerned that the measure still includes a flawed “median network average” mechanism to pay physicians who deliver care on an out-of-network basis – a pro-insurer average that often doesn’t reflect the full or true cost of providing the care, can’t be verified, and is easily manipulated.

Encourage your elected officials to…

1. Use fair benchmarks (e.g., that are based on actual local claims charges using an independent database).

2. Use a fair and independent provider/insurer dispute resolution (IDR) process.

3. Get patients out of the middle of the process by making insurers be responsible for the costs they are supposed to cover.

4. Require insurers to maintain an adequate network of physicians, especially in ER settings (e.g., on-call surgeons and anesthesiologists).

Contact MAG Government Relations Director Derek Norton at dnorton@mag.org with questions.

Contact Sen. Isakson by clicking here or calling 770.661.0999 and contact Sen. Perdue by clicking here or calling 404.865.0087. Click here to contact your U.S. Representative. 

PAI weighs in on ‘Consumer Protections Against Surprise Medical Bills Act’

The Physicians Advocacy Institute (PAI) has issued a statement to address the U.S. House Ways and Means Committee’s ‘Consumer Protections Against Surprise Medical Bills Act of 2020.’

PAI says that, “This bill, which was blessed by Committee Chair Richard Neal (D-Mass) and Ranking Member Kevin Brady (R-TX), differs from other surprise billing legislation because it does not include a payment benchmark for ‘surprise’ medical bills. Rather, it establishes a process for insurers and providers to negotiate privately to solve payment disputes and an independent dispute resolution process in the event private negotiations fail.”

PAI adds that, “Unfortunately, the legislation requires the mediation entity to consider the ‘median in network rate’ as determined by the insurer, and specifically prohibits consideration of the ‘usual and customary’ charges or the provider's billed charges. The CBO scores savings at $15 billion over 10 years.” 

And PAI stresses that it will “continue to advocate for a dispute resolution process that allows introduction of a range of data, including information on out-of-network charges and payments in the geographic area and any prior contractual rates between the insurer and provider. We also will continue to call for independent data and network adequacy oversight.”

PAI ‘Consumer Protections Against Surprise Medical Bills Act’ statement

‘Consumer Protections Against Surprise Medical Bills Act’ summary

Resources

MAG ‘Surprise Medical Bills’ fact sheet

PAI ‘Surprise Medical Bills’ web page

PAI [successful] New York Surprise Medical Bills law summary

AMA/specialty groups address key SB legislation considerations

PAI weighs in on New York surprise billing/IDR law

Sen. Alexander/Reps. Pallone & Walden Surprise Medical Bills “Compromise” Summary

ASA survey shows health insurers abruptly terminating physician contracts, dramatically cutting payment rates forcing physicians out of network

Articles

U.S. Rep. Rick Allen addresses need to end surprise billing in op-ed

House W&M releases ‘Surprise Medical Bills Act’ summaries

American Society of Anesthesiologists response to article on surprise medical bills

AMA: Ways & Means surprise bills plan may 'offer improvements' over 'compromise'

MAG opposing flawed federal surprise medical bills 'compromise'

Surprise medical bills becoming more frequent and costly

Bills from out-of-network doctors rising at in-network hospitals

Just how common are 'surprise' bills?