CMA urges Congress to follow New York's successful surprise billing model

CALAAEM News Service at
Tue Jul 23 23:09:28 PDT 2019


July 22, 2019


CMA urges Congress to follow New York's successful surprise billing model


ss-to-follow-New-York-s-successful-surprise-billing-model> CMA


Last week, the U.S. House Energy and Commerce Committee approved the "No
Surprises Act," which is intended to protect patients from the financial
hardship and emotional stress of surprise medical bills when their insurance
fails them. While the California Medical Association (CMA) is committed to
working towards a solution that protects patients from surprise medical
bills, we continue to oppose the underlying bill (H.R. 3630).


The "No Surprises Act" mirrors California's failing law in that insurers are
not incentivized to contract with physicians and offer an appropriate
network of physicians to ensure access to care. Like the California law,
H.R. 3630 would establish an extremely low payment benchmark for
out-of-network physicians and do not have an effective dispute resolution
process with an independent database of rates. 


While patients in California have been protected from surprise medical
bills, the rest of the law has not worked. Under California's surprise
billing law (AB 72, 2017), insurance company physician networks are
diminishing, patient access to in-network physicians is declining, patient
access to emergency physicians and on-call physician specialists is in
jeopardy, patient deductibles for out-of-network care are increasing, and
patient complaints about access to care have increased by almost 50%.


CMA is urging Congress to develop a more balanced approach that ends balance
billing but does not give insurers unilateral control of the market that
causes more out-of-network care. CMA believes that Congress should adopt a
system modeled after the successful New York law that has been in effect
since 2015. The law has helped keep insurance rate hikes in New York well
below the national average.


The New York system is a more balanced model that encourages physicians and
insurers to be more reasonable, resolve their disputes and enter into
contracts to ensure patients have an appropriate choice of physicians in
their insurance company networks.  There has been a 34% drop in
out-of-network billing because networks have stabilized.


CMA and the American Medical Association have secured some amendments to the
federal "No Surprises Act," including a provision that add an appeal process
for resolving out-of-network payment disputes. The addition of an appeals
process, albeit imperfect, represents progress. We will continue to work
with Congress to make further improvements on this and other elements in the


"CMA looks forward to continuing to work with the committee and others to
further improve this legislation," says CMA President David H. Aizuss, M.D.
"We must protect patients from surprise medical bills, while also making
sure rates paid by health plans are sufficient to ensure there are providers
available in hospitals, emergency rooms and clinics to treat patients who
need care."


CMA and AMA are backing an alternative approach to end surprise
billing-"Protecting People from Surprise Bills Act of 2019"-introduced by
four physician congressman physician congressmen Raul Ruiz, M.D., (D-CA),
Phil Roe, M.D., (R-TN), Ami Bera, M.D., (D-CA) and Larry Bucshon, M.D.
(R-IN), as well as Joseph Morelle (D-NY), Van Taylor (R-TX), Donna Shalala
(D-FL) and Brad Wenstrup (R-OH).


Based on New York state's successful law, this proposed legislation creates
incentives for physicians and insurers to contract and resolve their
differences. It also addresses the underlying cause of the problem - the
insurance industry's oligarchic market dominance - that has allowed insurers
to narrow their physician networks so patient access to physicians is


The CMA-backed proposal requires insurers to give patients a robust choice
of physicians, including hospital-based emergency physicians, and on-call
surgeons and anesthesiologist, who will be there for patients in life and
death emergencies. It allows insurers to pay commercial rates for
out-of-network care but if parties disagree, the proposed "baseball
arbitration" system encourages insurers and physicians to resolve their
disputes without costly lawsuits.




Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service


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