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Reading between the lines

| August 3, 2020

Reading between the lines

Legislative bills frequently contain measures addressing many issues and often unrelated topics are buried in the bills’ language. Recent attempts to develop a fourth COVID-19 relief legislative package included language about surprise medical billing.

The Advocacy Council, the American Medical Association and 113 state medical societies and national specialty organizations oppose the inclusion of surprise medical billing requirements in any new COVID-19 legislation package under consideration in Congress. The consortium of medical specialties expressed concerns in a comment letter to legislative leaders. These organizations strongly believe legislation to address the public health emergency is not the appropriate place or time to address surprise medical billing, since significant outstanding concerns remain.

Many physicians and physician organizations strongly believe the issues mentioned below are essential to any surprise medical billing legislative solution to ensure patients’ continued access to quality care.

The letter advocated:

  • Patient responsibility only for their in-network cost-sharing amounts, including deductibles, when receiving unanticipated medical care.
  • Keeping patients out of any payment disputes between health plans and providers and providing physicians with direct payment/assignment of benefits from the insurer.
  • Following the delivery of out-of-network medical care, a reasonable payment should be paid to providers.
  • If the provider determines that the insurer’s payment is not reasonable, there must be a fair, accessible and equitable independent dispute resolution (IDR) process to resolve payment disputes.
  • To prevent surprise medical bills from occurring in the first place, health plans should be held accountable for provider networks that are appropriate to meet patients’ medical needs, including ensuring access to specialists and subspecialists on a timely basis, including in a facility. Health plans must also ensure that provider directories are up to date and accurate.
  • Patients must be allowed to access elective out-of-network care when they so choose.

The letter emphasized the strain COVID-19 has placed on the medical community in the United States and urged Congress to refrain from actions that will further disrupt the healthcare system. It also emphasized the complexity of the surprise billing issue and advocated that the issue be addressed separately from any forthcoming COVID-19 relief legislation.

The House version of the fourth COVID-19 relief package – Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act – was amended in late July. Last week, Senate Republicans released their version of the fourth COVID-19 relief package known as the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act. The total cost of the Republican package is approximately $1 trillion, about one-third of the House-passed HEROES Act price tag.

Since some COVID-19 relief programs expired at the end of July, Congress faces pressure to send a final bipartisan package to the President for signature prior to adjourning for the August recess on August 10. We will continue to monitor and report on this legislation. The Advocacy Council – we have you covered.

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