End the surprise insurance gap

Physicians React to Alexander-Murray Surprise Billing Proposal

Date created

Thu, 05/23/2019 - 13:17

WASHINGTONPhysicians for Fair Coverage (PFC), a non-profit, non-partisan alliance of tens of thousands of physicians, issued the below statement on the surprise billing discussion draft proposal introduced by Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA):

“We appreciate Chairman Alexander and Ranking Member Murray’s desire to address the problem of surprise medical bills by removing patients from the middle, as many of the other proposed bills have done, but this proposal misses the mark,” said Dr. Sherif Zaafran, Chair of Physicians for Fair Coverage. “Congress should reject any proposal that boils down to government rate setting that would compound the doctor shortage and further restrict patient access to quality care, especially for those living in rural communities that are already devastated by hospital closures. Instead of allowing the federal government to pick winners and losers from the get-go, Congress should look toward the only solution to surprise billing that has a long track record of truly protecting patients: an independent dispute resolution (IDR) model. From Washington to Texas to New York, there has been a groundswell of support in the states for the successful IDR model that has resulted in stronger patient protections, a dramatic drop in out-of-network claims, and increased network participation and transparency for consumers. Now, there is momentum building in Congress for this same approach with the introduction of bipartisan legislation in the House this morning, and the growing support in the Senate for the bipartisan STOP Surprise Medical Bills Act.”

So far, 10 states and counting have enacted laws based on this approach, and the results in New York are proof positive that IDR works. In just two years, the number of patients who received out-of-network care dropped by 68 percent, and in 2017, only 645 claims—out of the more than 3 million emergency room visits in New York annually—went to an arbiter. Furthermore, according to a recent case study from Georgetown University’s Center on Health Insurance Reforms, New York state officials reported a “dramatic decline” in consumer complaints and that the law has downgraded the issue from one of the biggest [consumer concerns our call center receives] to barely an issue.” Despite concern that this model could inflate health care prices, the same study reported there has not been “an indication of an inflationary effect in insurers’ annual premium rate filings,” and most interestingthat insurer, provider, and consumer stakeholders generally agree that the law is fair to all parties, its implementation went smoothly, and it is working as intended to protect consumers.

Dr. Zaafran continued, “Earlier today, Representatives Raul Ruiz (D-CA-36) and Phil Roe (R-TN-01) led a bipartisan group of House members in introducing bipartisan legislation that is based on this same approach. At the same time, there is growing support in the Senate for the bipartisan STOP Surprise Medical Bills Act, a bill that includes a 30-day IDR process that removes patients from price negotiations entirely and does so in a way that will preserve their access to quality care. With more than 15 cosponsors on both sides of the aisle and strong bipartisan support in the House for a similar proposal, it’s clear that proven, compromise policy is the best solution to end surprise medical bills nationwide.”



Each year, millions of Americans seek emergency care at a hospital, and they do their best to ensure they receive care at an in-network hospital covered by their health insurance plan. However, even if patients receive care at an in-network hospital, they could be treated by an out-of-network physician, which may result in what is commonly referred to as a surprise or balance medical bill.