STATEMENT: PAMED Urges Congress to Go Back to the Drawing Board in Developing Solution to Surprise Billing

Last Updated: Dec 15, 2020

250x250 Surprise Billing

The following is a statement from PAMED President Michael DellaVecchia, MD, PhD, FACS, FICS, FCPP

Ten months into the COVID-19 pandemic, Pennsylvania physicians are being pushed
to the breaking point as hospital emergency departments are becoming overwhelmed and ICUs are quickly running out of available beds.

Normally, in a crisis like this, one would expect our Congressional representatives to be supporting these critical, frontline caregivers. Instead, efforts are underway in Washington to broker a deal on a “surprise billing” measure that would favor health insurers over these same physicians.

The Pennsylvania Medical Society (PAMED) strongly urges Congress to go back to the drawing board and put together a more balanced surprise billing proposal – one that does not diminish the essential role physicians play in delivering life-saving treatments.

Patients often find themselves in the middle of balance billing disputes when health insurers refuse to fairly negotiate with physicians. We agree that patients must be taken out of the equation. However, physicians must be reimbursed a commercially reasonable rate for out-of-network services and have a fair process for dispute resolution and arbitration. Any proposal without these safeguards will ultimately result in reduced access to care for patients.

Evidence exists showing that the “all reasonably necessary costs” standard and providing for independent dispute resolution have been proven both fair and effective elsewhere. New York state has used a similar process for almost five years and in that time, in-network participation has increased, out-of-network billing has been largely eliminated, more clinicians are in-network, and its system has been lauded by both clinicians and insurers for its effectiveness and fairness.

Our message to Congress is simple: Please put physicians and their patients first – not health insurers – in developing solutions to address surprise billing.

###

Media Contact

MediaRelations@pamedsoc.org 

About the Pennsylvania Medical Society

PAMED is a physician-led, member-driven organization representing all physicians and medical students throughout the state. We advocate for physicians and their patients, educate physicians through continuing medical education, and provide expert resources and guidance to help physicians and their organizations navigate challenges in today’s ever-evolving health care system. For more information, visit www.pamedsoc.org.

1 comment

Leave a comment
  1. Gerard Margiotti | Dec 17, 2020
    When will we have real time adjudication of insurence coverage? It is unbelivable that we do not know for sure when we provide service if it is covered or not!

    Login to be able to comment

    Leave a comment

    ng5136-PA-PAMedSociety-DigitalAd-Brand-300x225
    Norcal Mutual

    Learn More 
    ng5136-PA-PAMedSociety-DigitalAd-Brand-970x90