Congress is working on H.R. 3502, a “Surprise Medical Bill.” I encourage you to support physician reimbursement by contacting your representative in the US House of Representatives.
What this bill would require: Patients who receive medical care would be covered for that care by their insurance, by law. The insurer would be required by the bill to pay a fair and reasonable amount for the care that their insured receive, not denied, and not paid some pittance or some arbitrary amount decided unilaterally by the insurance company.
Why this is important: Currently, when patients come to the hospital for emergency care or for emergency admission, the insurance companies may not cover or pay for the care provided. The insurance company may pay very little, less than the cost of providing the care, or they may pay nothing to physicians who are not in their increasingly narrow networks. This inadequate payment or no payment by the insurance company is made despite the fact that emergency care, emergency hospital admission, and necessary emergency consultations of appropriate specialists are all mandated directly or indirectly by the federal EMTALA law along with state laws preventing patient abandonment without regard to the ability to pay or whether an insurance company will cover the cost of care.
What you can do: Go to the website link below and contact your representative in the US House of Representatives. Please help protect doctors against predatory insurance companies by supporting this law.July 6, 2019 at 4:33 am MST #228146
Ah, the auto-fill email to Congress, that powerful tool driving legislative agendas.
The corporate and private equity owned medical ventures that bilk the system with surprise bills are employing far more effective lobbying tools to keep their gravy train going.
Our group is small private group of physicians. This bill would help us too.
You missed the point. Emails like this to congressional reps are effectively worthless. The point of this bill isn’t to help doctors, it’s to curtail the sleazy PE and corporate ventures that purposefully stay out of network to bilk the system.
They reap millions by doing that. So, they’ll spend that money on things that actually get congressional reps to vote their way, like campaign $$$ and no show jobs for relatives.
Have you read the bill you’re promoting (prob not since it actually hasn’t been made available as of this AM)?
“This bill will help us, too.” You sure? From what you read in the bill, right? It’s actually likely to be a negative for groups like yours that likely have favorable insurance contract rates.
Read up on it before you go rallying the troops.July 6, 2019 at 8:32 am MST #228192
The hope is that the bill will:
1. Protect doctors from not being paid
2. Protect patients from receiving outrageous bills from providers/corporations that are totally out of line for the services provided
The American College of Emergency Physicians is supporting the bill. Hopefully that’s because they are looking out for the physicians. Of course there could be corporate influence. However, our smaller group has struggled to get reasonable in network rates. We would totally prefer to be in network, but not when the insurance companies are going to screw us by offering much less than the going rate for care.DreamgiverParticipantStatus: PhysicianPosts: 894Joined: 03/09/2017
I posted this 2 weeks ago:
This was the outcome:
Although tying out-of-network reimbursement to Medicare rates was removed from the bill, it still includes rate setting based on median in-network rates and excludes independent dispute resolution, thereby favoring insurance companies in billing disputes. There was discussion of continuing to work with Senator Cassidy, who advocates an arbitration model, as the Senate bill works its way through the legislative process.
On the House side, please contact your representative and encourage him to co-sponsor a bill proposed by Congressman Raul Ruiz MD (D-CA) and Congressman Phil Roe MD (R-TN) Protecting People from Surprise Medical Bills Act. This bill is based on the New York model that protects patients while balancing the interests of physicians and insurance companies. It also creates an Independent Dispute Resolution (IDR) process.PanscanParticipantStatus: ResidentPosts: 1151Joined: 03/18/2017
Not sure some body of em docs supporting something means anything. Under the same thinking we should agree with whatever the AMA says, even though they clearly don’t represent most doctors interests as multiple surveys show.July 20, 2019 at 6:08 pm MST #232233GParticipantStatus: Physician, Small Business OwnerPosts: 1876Joined: 01/08/2016
Interestingly, this is a good example of how professional societies are helpful with lobbying. Your article is dated, the arbitration method discussed has been added to the current markup.
Unfortunately, the threshold is $1000, which would preclude too many profedsional services. We will see how that evolves.
A law is going to be passed. ZZZ and panscan, what is your suggestion for affecting the final language?July 20, 2019 at 10:29 pm MST #232267southernerdocParticipantStatus: PhysicianPosts: 79Joined: 03/10/2019
This may have difficulty passing this legislative session. It will reappear next year if it doesn’t.July 20, 2019 at 10:37 pm MST #232268fasteddie911ParticipantStatus: PhysicianPosts: 310Joined: 05/31/2016
Mostly I’m on the docs side on this, but as a recipient of an outrageous balance bill I’m not surprised it has come to this and we, or at least some of us, have to take blame. A few bad apples ruin the bunch.July 21, 2019 at 4:51 am MST #232277
NY State has a great law on surprise bills. It has been in effect for years. It is a balanced law that protects patients from price gouging and it protects doctors from the insurance companies setting ridiculously low, in network rates.
The pricing anchor in the NY surprise bill law is the RUC rate published by fairhealth. Those RUC rates are about 3x medicare. The doc gets paid around $300 to care for a complex ED patient. This is fair to the doc, and it protects the patients. Of course, this is only for the commercially insured patients.
The large contract management groups have been sending bills for thousands of dollars to out of network patients. This is price gouging and the patients need protection from some of these groups. This price gouging is going to murder the hen that lays the golden eggs.
Looking at this from another perspective, the ED docs are mandated by federal EMTALA law to care for all patients. This includes requiring the docs to provide free care to those who are poor, undocumented, and uninsured. This includes the docs caring for medicaid patients and giving them their time and expertise to care for complex medical emergencies for less than $40 in reimbursement. To me, the EMTALA law requiring the docs to provide care is good one, but that law will collapse under its own weight if there is no way for the docs to get paid a reasonable wage for the care they provide. If a law passes giving the insurance companies all the power, working in an ED could become indentured servitude with very low reimbursement.
Bottom line, the NY state surprise bill law is a good one because the charges it allows are reasonable compensation and allow for the docs to make up for some of the legally mandated free care that they provide under EMTALA. The anchor for the charges in any new federal law is the key issue to success or failure of the law. Allowing the insurance companies to set those rates will be a recipe for disaster for the safety net provided by our EDs in this country.ZaphodParticipantStatus: Physician, Small Business OwnerPosts: 6335Joined: 01/12/2016
Mostly I’m on the docs side on this, but as a recipient of an outrageous balance bill I’m not surprised it has come to this and we, or at least some of us, have to take blame. A few bad apples ruin the bunch.Click to expand…
Agree some is self inflicted, but I’d bet the biggest users of said practices are the PE/Corp owned practices set up to specifically be out of network, and hospitals themselves contracting ED coverage with said groups for the purpose of balance billing as a first principal.GParticipantStatus: Physician, Small Business OwnerPosts: 1876Joined: 01/08/2016
Some of it is PE squeezing the teat too hard. Some of it is from the groups that cover unprofitable sites and/or lines. Think poor payer mix plus having to fund hospitalists, which are net loss (I am still flabbergasted by this). Some of it is plain bad apples.
It will be interesting to see how it all shakes out. I dont see any abrupt changes, more of the insidious scenario of frog in pot being brought to a boil….
Btw, again, those of us in red districts prefer to call thos “baseball style arbitration ” as opposed to the “New York ” model!July 21, 2019 at 9:42 am MST #232347