Last Updated: Oct 31, 2019
Surprise medical bill/balance billing legislation (HB 1862) would set a benchmark rate in statute for out-of-network providers. The bill would determine the payment rate and calculate reimbursement for providers based on median in-network rates for out-of-network care. By defining this rate, the bill sets in statute a state-mandated price control, not only on out-of-network care, but on all future negotiations between clinicians and insurance companies.
Out of Network Services ≠ In-Network Rates
We need you to call and/or email your Representative NOW and ask them to support AMENDING HB 1862 by voting YES for:
- The Kaufer amendment (#A3599) – Supported by the provider community, this amendment will remove the median in-network rate as the state mandated payment standard and put in its place “all reasonably necessary costs,” which is the existing payment standard for emergency services in our state and has been for the past 20 plus years.
- The Rothman amendment (#A3601) – As currently drafted, this bill only permits arbitration to look at the accuracy of a payment determined by an insurer, with no checks and balances in place.This amendment calls for independent dispute resolution (IDR) to look at whether the payment is appropriate.Further, it encourages fair physician claims and insurer payments from the beginning, as both sides rise additional expense if take to IDR through the American Arbitration Association (AAA).
Contact your legislator by clicking on the button below:
While the bill was scheduled to be considered before the legislative break, consideration has been postponed until legislators return in mid-November.
These are critical amendments that health insurers are trying to kill. Representatives need to hear from YOU RIGHT NOW on the negative impact HB 1862 will have on your practice and your ability to provide care to their constituents if these amendments are not adopted.
While the bill deals with payment for out-of-network providers, this benchmark rate-setting will impact ALL future contract negotiations with insurers trying to move in-network providers to this state-mandated rate, undermining a physician's right to negotiate a fair contract.
Providers in the Commonwealth need a choice to accept or reject contract terms. Without this fundamental component of the health care system, insurers will have a stronghold.
Here are some key points:
- We support efforts to take the patient out of the middle but need to craft a bill that is fair.
- This takes away the ability of ALL providers to fairly negotiate contracts.
- Insurers will become more powerful and further increase their control over health care.
- We support giving insurers the ability to determine the payment rate based on market forces as long as it is combined with an independent dispute resolution mechanism that has specific criteria to look at appropriateness of both the provider claim and the insurer payment.
- In tandem, the two amendments establishing 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 system has been lauded by both clinicians and insurers for its effectiveness and fairness.