AAOS October 30, 2018
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AAOS Offers Recommendations on Proposed EHR Reporting Program

Advocacy In Action

Bills Introduced to End Surprise Billing for Out-of-Network Care

AAOS Advocates For Anti-Kickback Reform, Reduced Burdens on Care Coordination

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House of Representatives Legislative Activities

Senate Legislative Activities
Bills Introduced to End Surprise Billing for Out-of-Network Care

As the 115th Congress nears an end, several senators have introduced legislation to prevent patients from receiving surprise bills for care that they may not have realized was out-of-network. Surprise bills can happen any time, but they frequently happen during emergency care, when patients and doctors have no way of knowing who is in and out-of-network.

A bipartisan working group in the Senate has produced draft legislation called the Protecting Patients from Surprise Medical Bills Act. The proposal bans “balance billing,” or the practice of billing a patient for the balance of the bill not covered by insurance, for emergency services and out-of-network care provided at in-network facilities. The legislation’s payment methodology for determining out-of-network reimbursement gives insurers the ability to determine usual and customary rates for emergency care and could create an incentive for insurers to systematically drive physician payments downward.

AAOS has joined with the American Society of Plastic Surgeons to write a comment letter to the authors of the Protecting Patients from Surprise Medical Bills Act. In it, AAOS advocates for adequate health insurance networks, holding patients harmless under all circumstances, retaining a balance billing option, insuring fair and timely payment, and maintaining uniformity of self-insured health insurance plans. AAOS is committed to a solution that takes patients out of the middle, by requiring insurers to handle unexpected out-of-network bills directly with physicians. Requiring insurance companies to cover unexpected out-of-network care directly with providers at a fair rate will protect patients from surprise bills in emergency situations, strengthen patient networks, and increase access to care for patients. 

Senator Jeanne Shaheen (D-NH) and Senator Maggie Hassan (D-NH) have also introduced companion proposals that address surprise out-of-network bills. The Reducing Costs for Out-of-Network Services Act of 2018, sponsored by Shaheen, would cap the amount that hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage. The No More Surprise Medical Bills Act of 2018, sponsored by Hassan, would prohibit hospitals and providers from charging more than the in-network amount for patients with employer-sponsored health plans.

None of the proposals are likely to pass before the end of the session in December and will need to be reintroduced in the 116th Congress. They are, however, a preview of the items that may be on the agenda should Democrats hold a majority in the House or Senate.

Read the full AAOS comment letter on the Protecting Patients from Surprise Medical Bills Act here.