<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:dt="uuid:C2F41010-65B3-11d1-A29F-00AA00C14882" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40"><head><meta name="Microsoft Theme 2.00" content="CALAAEMNStemplateJuly2018v3.htm 011"><meta http-equiv=Content-Type content="text/html; charset=us-ascii"><meta name=Generator content="Microsoft Word 15 (filtered medium)"><!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Verdana;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri",sans-serif;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:#954F72;
text-decoration:underline;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri",sans-serif;}
span.EmailStyle17
{mso-style-type:personal-compose;
color:black;}
.MsoChpDefault
{mso-style-type:export-only;
font-family:"Calibri",sans-serif;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:1532110716;
mso-list-type:hybrid;
mso-list-template-ids:372522450 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:\F0B7;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:51.0pt;
text-indent:-.25in;
font-family:Symbol;}
@list l0:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:87.0pt;
text-indent:-.25in;
font-family:"Courier New";}
@list l0:level3
{mso-level-number-format:bullet;
mso-level-text:\F0A7;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:123.0pt;
text-indent:-.25in;
font-family:Wingdings;}
@list l0:level4
{mso-level-number-format:bullet;
mso-level-text:\F0B7;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:159.0pt;
text-indent:-.25in;
font-family:Symbol;}
@list l0:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:195.0pt;
text-indent:-.25in;
font-family:"Courier New";}
@list l0:level6
{mso-level-number-format:bullet;
mso-level-text:\F0A7;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:231.0pt;
text-indent:-.25in;
font-family:Wingdings;}
@list l0:level7
{mso-level-number-format:bullet;
mso-level-text:\F0B7;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:267.0pt;
text-indent:-.25in;
font-family:Symbol;}
@list l0:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:303.0pt;
text-indent:-.25in;
font-family:"Courier New";}
@list l0:level9
{mso-level-number-format:bullet;
mso-level-text:\F0A7;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:339.0pt;
text-indent:-.25in;
font-family:Wingdings;}
@list l1
{mso-list-id:1698852720;
mso-list-type:hybrid;
mso-list-template-ids:-924161596 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l1:level1
{mso-level-number-format:bullet;
mso-level-text:\F0B7;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;}
@list l1:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";}
@list l1:level3
{mso-level-number-format:bullet;
mso-level-text:\F0A7;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;}
@list l1:level4
{mso-level-number-format:bullet;
mso-level-text:\F0B7;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;}
@list l1:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";}
@list l1:level6
{mso-level-number-format:bullet;
mso-level-text:\F0A7;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;}
@list l1:level7
{mso-level-number-format:bullet;
mso-level-text:\F0B7;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;}
@list l1:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";}
@list l1:level9
{mso-level-number-format:bullet;
mso-level-text:\F0A7;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;}
ol
{margin-bottom:0in;}
ul
{margin-bottom:0in;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal align=center style='text-align:center'><span style='font-size:9.5pt'><img width=540 height=163 style='width:5.625in;height:1.6979in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_1" src="cid:image001.jpg@01D4CDFB.BCDA3750" alt="cid:image003.jpg@01D413DA.65584930"></span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782content"><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#7F7F7F'>Feb. 25, 2019</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'> </span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'>How states can take the lead on mitigating surprise out-of-network billing</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#0070C0'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><a href="https://www.fiercehealthcare.com/hospitals-health-systems/hospital-groups-push-for-seat-at-table-surprise-billing-problem?mkt_tok=eyJpIjoiWWpFd01HVXlaamhsTlRnNSIsInQiOiJBQU1hcWZWWUJzVktmYm9aYjBBd2ZCOFVkeTVqUTJiVzROMTBJRHQzVzhXY1wvK01NYU5PV1Ftc0U5djF3aEh0UHNqc0xBM1wvQ3l2Q1htMFJhK0xuWGd5QVJ4Z25NT3VaWFAwb1d5V0ltTVRoUit2UHNQV1VLUjc4TytyVlhBS0w4In0%3D&mrkid=905528&utm_medium=nl&utm_source=internal"><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#1155CC'>FierceHealthcare</span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>by Jacqueline Renfrow | Feb 20, 2019 4:08pm</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>There are policy options, at the state level, which could help mitigate the costs of surprise out-of-network billing. According to a recent report from the USC-Brookings Schaeffer Initiative for Health Policy, surprise out-of-network costs, such as ambulance transports or care delivered by an out-of-network physician at an in-network hospital, are a huge burden.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>If not prohibited by the state’s law, 1 in 5 visits to the emergency department results in a surprise out-of-network bill. And 50% of all ambulance cases involved an out-of-network ride in 2014, according to the report.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>“The financial consequences of surprise out-of-network bills can be substantial,” noted the paper. Especially for patients enrolled in HMOs, who can be liable to provide payment for all charges on out-of-network care.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>According to data in the report, collected from a large national insurer, out-of-network emergency physicians charged about eight times what Medicare pays for the same service. And a survey of American Society of Anesthesiologists reports that contracted payments to anesthesiologists averaged 350% of the Medicare rates in 2018.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Plus, the costs can also be high for the physicians who are charging for out-of-network billing. These doctors often end up settling with patients or health plans for payments below what was fully charged. Collecting an out-of-network bill has more administrative hassle, too, according to the report. <o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>But the problem lies at the hospital level, where it would be more expensive to require its out-of-network physicians to go in network, in turn, making it more expensive for insurers to encourage hospitals to take this approach, the report found. Then, physicians would most likely require higher stipends to compensate for the loss of income.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Therefore, the demand would likely need to come from patients asking that hospitals pay the balance to physicians, which is unlikely as many patients only require these arrangements in an emergency or are not aware of surprise out-of-network charges at all, the report said.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Still, the American Hospital Association (AHA) and several other hospital groups sent a letter (PDF) urging Congress to enact legislation that protects patients from surprise medical payments. <o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>"The last thing a patient should worry about in a health crisis is an unanticipated medical bill,” AHA President and CEO Rick Pollack said in a statment. "We must protect patients from surprise bills that could unintentionally impact their out-of-pocket costs and undermine the trust and confidence patients have in their caregivers.”<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The Brookings paper sets forth five approaches that individual states need to consider in order to change the current policies surrounding surprise out-of-network billing. <o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:0in;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Take the patient out of the equation and require insurers and providers to resolve the problem and payment.<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:0in;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Patients should be made aware of all out-of-network services within a facility before a procedure occurs. <o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:0in;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>States should limit or ban all billing without prior consent, in writing, from patients. <o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:0in;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>States have the power to manage enforcement through existing processes for managing licensure and certification and resolving patient disputes. <o:p></o:p></span></li></ul><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:30.7pt;margin-bottom:0in;margin-left:15.0pt;margin-bottom:.0001pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:0in;mso-list:l1 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Due to ERISA—which bars states from regulating self-insured employer health plans—state policy needs to focus on the regulation via health care providers. <o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Brookings suggests a policy setting “billing regulation,” which caps or sets limits on what out-of-network providers can charge patients in surprise situations.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The second approach, “contracting regulation”, makes it impossible for services to be out-of-network when the facility itself is in network. Although if new contracts are formed, facilities will need to be mindful of state kick-back laws and rules about the contracts between healthcare providers and insurers. <o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The paper also suggests a billing regulation approach or a hybrid approach, drawing upon billing regulation and contracting regulations. The authors believe either two options could be enacted on the federal level as well, with only a few modifications. <o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>“If pursuing option No. 1, the federal government could require self-insured (in addition to fully-insured) health plans to hold enrollees harmless for any costs beyond normal in-network cost- sharing amounts associated with surprise out-of-network services,” the paper noted. “If enacting a federal solution, Congress would also have to decide whether to supersede existing state reforms, which range widely in their comprehensiveness and effectiveness.” <o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:30.7pt;margin-bottom:0in;margin-left:15.0pt;margin-bottom:.0001pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The letter to Congress agreed with the sentiment that federal decisions should be mindful of state regulations and ultimately leave patients out of any payment debates.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#7F7F7F'>Feb. 25, 2019</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal style='mso-margin-top-alt:11.25pt;margin-right:0in;margin-bottom:11.25pt;margin-left:0in'><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'>Hospital groups push for seat at table as lawmakers address 'surprise billing’</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#0070C0'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p></div><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#0070C0'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><a href="https://www.fiercehealthcare.com/hospitals-health-systems/hospital-groups-push-for-seat-at-table-surprise-billing-problem?mkt_tok=eyJpIjoiWWpFd01HVXlaamhsTlRnNSIsInQiOiJBQU1hcWZWWUJzVktmYm9aYjBBd2ZCOFVkeTVqUTJiVzROMTBJRHQzVzhXY1wvK01NYU5PV1Ftc0U5djF3aEh0UHNqc0xBM1wvQ3l2Q1htMFJhK0xuWGd5QVJ4Z25NT3VaWFAwb1d5V0ltTVRoUit2UHNQV1VLUjc4TytyVlhBS0w4In0%3D&mrkid=905528&utm_medium=nl&utm_source=internal"><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#1155CC'>FierceHealthcare</span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>by Tina Reed | Feb 21, 2019 8:54am</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>As the problem of "surprise billing" at hospitals around the country gains scrutiny from the White House and Congress, a collection of major hospital groups indicated they want a hand in shaping the conversation.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>In a letter sent to Congressional leaders on Tuesday, the groups—which include the American Hospital Association and Federation of American Hospitals—laid out principles they want lawmakers to consider as they seek to address the problem over the next few months.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Specifically, their solutions took aim at policies by health payers and called for protections for patients but notably also opposed the controversial practice of balance billing by providers.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>It's the latest in the back and forth in the industry over who is actually to blame for surprise medical bills, or the practice of charging patients for care that is more expensive than anticipated or not covered by their insurance. In December, a group of insurance, business and consumer groups announced they'd banded together to push for stronger patient protections and released their own guiding principles for the conversation.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>"We are fully committed to protecting patients from “surprise bills” that result from unexpected gaps in coverage or medical emergencies," the letter from the hospital groups, which also included America’s Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States and the Children’s Hospital Association said.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>"We appreciate your leadership on this issue and look forward to continuing to work with you on a federal legislative solution," they said.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Among the principles, they called for:</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:30.7pt;margin-bottom:0in;margin-left:15.0pt;margin-bottom:.0001pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Congress to define "surprise bills" saying they may occur when a patient receives care from an out-of-network provider or when their health plan fails to pay for covered services. They also called for policies to protect patients financially and said providers should not balance bill, meaning they should not send a patient a bill beyond their cost-sharing obligations.<o:p></o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:15.0pt;mso-list:l0 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Protections for patients seeking emergency care from being denied payment by a payer if, in retrospect, the health plan determines was not an emergency. They also supported moving the patient from health plan/provider negotiations, saying health plans must work directly with providers on reimbursement, and the patient should not be responsible for transmitting any payment between the plan and the provider.<o:p></o:p></span></li></ul><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:30.7pt;margin-bottom:0in;margin-left:15.0pt;margin-bottom:.0001pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:15.0pt;mso-list:l0 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The preservation of the role of private negotiation between health plans and providers in determining appropriate payment rates.<o:p></o:p></span></li></ul><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:30.7pt;margin-bottom:0in;margin-left:15.0pt;margin-bottom:.0001pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:15.0pt;mso-list:l0 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>"The government should not establish a fixed payment amount or reimbursement methodology for out-of-network services, which could create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks," the groups wrote. <o:p></o:p></span></li></ul><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:30.7pt;margin-bottom:0in;margin-left:15.0pt;margin-bottom:.0001pt;text-indent:3.0pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='margin-right:45.7pt;margin-left:15.0pt;mso-list:l0 level1 lfo2'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Ensuring patients have access to comprehensive provider networks and accurate network information through their health plans. Hospitals have received criticism that surprise bills have resulted in emergency departments or surgical procedures when a patient receives care in an in-network hospital by an out-of-network healthcare provider.<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The letter came the same day as a Brookings Institution report which said 1 in 5 visits to the emergency department results in a surprise out-of-network bill in states that don't prohibit them. About half of all ambulance cases involved an out-of-network ride in 2014, according to the report.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.75pt'><span style='font-size:9.5pt'> <o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.75pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.75pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><strong><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'> <o:p></o:p></span></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>Contact us at: </span><a href="mailto:calaaem.news.service1@gmail.com" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>calaaem.news.service1@gmail.com</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'><br><br>For more articles, visit our </span><a href="https://www.aaem.org/get-involved/chapter-divisions/calaaem/news-service" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>archives</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>. <br><br></span><a href="mailto:somcaaem@uci.edu" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a><a href="https://maillists.uci.edu/mailman/listinfo/calaaem" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#0070C0;text-decoration:none'> </span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>unsubscribe</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2018. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span><span style='font-size:9.0pt'> </span><a href="http://www.calaaem.org/" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>http://www.calaaem.org</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>Follow CAL/AAEM on Facebook and Twitter and check out WestJEM:</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><a href="http://www.facebook.com/CALAAEM" target="_blank"><span style='font-size:9.5pt;color:black;text-decoration:none'><img border=0 width=40 height=40 style='width:.4166in;height:.4166in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_2" src="cid:image002.jpg@01D4CDFB.BCDA3750" alt="cid:image002.jpg@01D0A9FD.796449A0"></span></a><span style='font-size:9.5pt'> </span><a href="https://twitter.com/CALAAEM" target="_blank"><span style='font-size:9.5pt;color:windowtext;text-decoration:none'><img border=0 width=43 height=43 style='width:.4479in;height:.4479in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_3" src="cid:image003.jpg@01D4CDFB.BCDA3750" alt="cid:image003.jpg@01D0A9FD.796449A0"></span></a><span style='font-size:9.5pt'> </span><a href="https://westjem.com/" target="_blank"><span style='font-size:9.5pt;color:windowtext;text-decoration:none'><img border=0 width=160 height=43 style='width:1.6666in;height:.4479in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_4" src="cid:image004.jpg@01D4CDFB.BCDA3750" alt="cid:image004.jpg@01D0A9FD.796449A0"></span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.5pt;color:black'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='text-decoration-style:initial;text-decoration-color:initial'><span style='font-size:9.5pt'> <o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>