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Surprise Billing in National Spotlight as Lawmakers Consider the No Surprises Act

Last Updated: Sep 5, 2019

medical-billThe issue of “surprise billing,” in which patients receive an unexpected medical bill for health care they believed would be covered by their insurance, is under scrutiny by lawmakers in Washington, D.C.

The No Surprises Act (HR 3630) was introduced in the House this past July and aims to address surprise medical bills.

PAMED Shares Concerns about No Surprises Act and Its “One Size Fits All” System

The Pennsylvania Medical Society (PAMED) believes that patients should not suffer because of issues with insurance companies. However, we have concerns with the No Surprises Act as currently written.

The legislation aims to resolves payment disputes between physicians and insurers through a benchmarking process that would set out-of-network payments at the median amount each insurer pays for in-network care. PAMED is concerned that:

  • Benchmarking will create a health care marketplace that reduces access to emergency care and other critical specialties, especially in rural communities.
  • This is a “one size fits all” system that disregards variable costs of health care and could result in clinicians being underpaid for the care they provide.

On Sept. 4, 2019, PAMED Board Chair John Gallagher, MD sent this letter to Reps. Susan Wild (PA-07), Fred Keller (PA-12), Mike Kelly (PA-16), and Brendan Boyle (PA-2). We urged the lawmakers to reconsider the approach taken in the current version of the No Surprises Act.

“We support efforts to protect patients from surprise medical bills so long as the solution prevents government price setting or influencing the negotiations between two private parties,” wrote Dr. Gallagher.

PAMED joins the American Medical Association in urging lawmakers to consider alternative solutions to address surprise billing.

PAMED Advocacy on Out-of-Network Billing

Out-of-network billing – including related issues such as narrow networks – is one of PAMED’s advocacy priorities for 2019. You can learn more about efforts to address the issue at the state level here.

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