Payers, providers dig in on surprise billing proposals

By | June 12, 2019

Payers and providers are drawing sharper lines in the sand on varying approaches to regulating surprise medical billing ahead of a third hearing on the topic in Congress in as many months.

America’s Health Insurance Plans and the Blue Cross Blue Shield Association formed the Coalition Against Surprise Medical Billing to advocate for legislation including a set rate for out-of-network services. The group of employers and payers plans to launch a multimillion-dollar ad campaign geared toward policymakers inside the Beltway across digital, print, radio and social platforms.

The Federation of American Hospitals blasted the group in a blog post Tuesday as pushing for policies that would create more problems than they solve. “The same people who brought us high deductible plans and narrow networks now expect patients to trust them to solve the surprise billing crisis,” the group wrote.

Several pieces of legislation banning the practice have been introduced this session, but they differ on key aspects of how out-of-network doctors would be paid and how disputes between payers and providers would be settled.

Congress will hear more talk of surprise billing next week when a package of bills put forward by the Senate HELP Committee gets a markup. The committee’s draft legislation includes three options for resolving the issues: an in-network guarantee (which hospitals oppose) a set rate (which hospitals and providers oppose) or arbitration (which payers are against).

Other members of the recently launched coalition include the National Retail Federation, American Benefits Council and National Association of Health Underwriters. It also has one member representing providers — America’s Physician Groups.

That group, formerly known as CAPG, represents more than 300 practices that use capitated, coordinated care models. 

AHIP will have a representative testifying Wednesday to the House Energy & Commerce Subcommittee on Health, along with the American Hospital Association and American College of Emergency Physicians.

Another witness will speak on behalf of the air ambulance sector, which both payers and providers have said should be included in surprise billing regulation. In prepared testimony, Association of Air Medical Services CEO Rick Sherlock railed against some payers he says have “outright refused to even discuss an in-network agreement with emergency air medical providers.”

AAMS is against a payment rate that uses Medicare as a metric, saying such a policy would “end air medical transport in the United States, limiting services only to those communities who choose to provide them as a public service or hospitals willing to subsidize the bulk of the cost.”

Also part of the new coalition is the ERISA Industry Committee (ERIC), which represents self-insured employers. ERIC SVP for Health Policy James Gelfand, who will also testify Wednesday, told Healthcare Dive he sees increasing consensus in Congress that surprise billing legislation should be passed this year.

Gelfand said he had expected most providers would support the policies his group has suggested, since surprise billing originates from a relatively small percentage of doctors. “For whatever reason, those provider groups have circled the wagons, so you’ve got the good guys sort of defending the bad guys,” he said.

The White House has also weighed in on the issue, and against arbitration specifically. President Donald Trump called surprise billing “one of the biggest concerns Americans have about healthcare.”

And several states have passed their own bills banning the practice, though state legislation cannot regulate employer plans, which cover most Americans.

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