MAG opposing language in federal “surprise bills” legislation

The Medical Association of Georgia (MAG) is opposing the provisions that are in the federal ‘Lower Care Costs Act’ that would enable health insurance companies to shift costs that they should bear to physicians and other health care providers and make it more difficult for patients to get access to the care they need.

“This measure is clearly designed to pad the health insurance industry’s bottom line, it’s going to limit patients’ access to care, especially when it comes to emergency settings, and it fails to address the root cause of surprise medical bills, which is narrow insurance networks,” says MAG President Rutledge Forney, M.D.

Dr. Forney explains that under this legislation, “Insurers would be able to shift some of their costs to out-of-network health care providers who care for patients who don’t have access to an in-network provider. These insurers would increase their profits by reimbursing these health care providers based on a ‘median in-network’ rate.”

She stresses that, “This model is flawed because median in-network rates often don’t reflect the true or full cost associated with providing the care, they can’t be verified, they are easily manipulated, and they result in narrower networks – which means less access for patients.”

Dr. Forney believes that, “Insurers should be transparent about what they charge for out-of-network care, and they should be required to maintain accurate and up-to-date provider directories so patients can make informed decisions about their care.”

She also emphasizes that, “MAG believes that patients who don’t have an opportunity to select an in-network provider (e.g., during an emergency) because of a limited insurance network shouldn’t have to pay a penny more than they would have paid in-network.”

Fellow MAG member and Georgia Chapter of the American College of Emergency Physicians President John Sy, D.O., says that, “A federal solution that helps take patients out of the middle of the billing disputes that arise between insurers and providers would be great, but that’s not going to be the case with these particular provisions. The only big winner, here, would be the health insurance industry.”

Dr. Sy points out that U.S. lawmakers are also considering a better solution for reimbursing out-of-network providers, which is the ‘Protecting People from Surprise Medical Bills Act’ by Reps. Raul Ruiz, M.D., and Phil Roe, M.D. – legislation that addresses geographic differences and calls for neutral third parties to resolve disputes and reconcile differences between insurers and health care providers.

“This is a fair and proven approach that has been enacted in New York,” he reports. “In fact, a recent Georgetown University analysis found that the charges associated with out-of-network physicians is down by 13 percent and out-of-network billing is down by 34 percent in New York since the law went into effect in 2014.”

Dr. Sy concludes that, “A trip to the ER can be an incredibly stressful experience, so getting quality care as soon as possible should be the number one priority – not trying to figure out which providers are in-network or worrying about their bill.”

Sen. Johnny Isakson is a member of the Senate Committee on Health, Education, Labor and Pensions committee that will vote on the ‘Lower Care Costs Act’ this Wednesday, June 26.