The Medical Association of Georgia (MAG) is encouraging every physician in the state to contact their U.S. representative as soon as possible to educate them about two “surprise billing” measures that they could be asked to consider in the coming days or weeks.

The first is a fair and sustainable solution (H.R. 3205) by Reps. Raul Ruiz, M.D. (D-Ca.) and Phil Roe, M.D. (R-Tenn.).

The second is a flawed, insurer-friendly measure – the ‘No Surprises Act’ – that the House Committee on Energy and Commerce Subcommittee will hold a hearing on this Wednesday, July 10.

H.R. 3205 is similar to a measure that was enacted in New York in 2013 that relies on neutral third parties to resolve insurer/provider disputes and that holds patients financially harmless. A Georgetown University analysis determined that this successful approach…

– Has reduced the charges associated with out-of-network physicians by 13 percent.

– Has resulted in fewer patient consumer complaints of surprise bills.

– Has resulted in health insurance premium increases that are below the national average. 

– Has protected patients’ access to on-call surgeons and other specialists in emergency care settings. 

– Relies on a transparent and comprehensive data set that is collected by a national, independent, non-profit entity that excludes outlier charges to establish the benchmark for payment and makes it difficult for insurers to manipulate in-network payment rates.

– Takes key factors into account, including the usual and customary cost of the service, charges and payments for non-contracted providers for comparable services, and the complexity of the case – as well as the provider’s level of education, training and experience.

– Requires insurers to maintain adequate physician networks and accurate network provider directories and to provide clear and transparent information about their plan’s out-of-network benefits and cost-sharing.

Meanwhile, the “No Surprises Act” is similar to California’s failing, two-year-old law that…

– Relies on “median in-network rates” that are established by insurers.

– Allows insurers to pay these emergency medicine providers the median in-network rate for all non-emergency care that is provided to patients who are out-of-network.

– Allows insurers to cut physician reimbursement for “emergency providers” (i.e., anesthesiologists, pathologists, radiologists, neonatologists, assistant surgeons, hospitalists, intensivists, or others based on the HHS definition), subject physicians to “take it or leave it” contracts, or simply terminate physician contracts at will.

– Sets an artificially-low payment rate for out-of-network care, which results in narrower networks and reduces patient choice and access to essential health care services – especially in emergency settings.

– Has resulted in a 48-percent increase in patients’ complaints about access to care.

– Is expected to force physicians to close their practice or sell their practices to hospitals or larger systems.

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