The American Medical Association is accusing America’s Health Insurance Plans of mischaracterizing House surprise-billing legislation and how it would affect healthcare stakeholders.
In a July 24 letter to House Energy and Commerce Committee leaders, the AMA addressed the insurance group's comments about the most recent version of the No Surprises Act. The letter states that insurers incorrectly said providers would be allowed to "price gouge patients" under the legislation.
"This is a clear mischaracterization of the actions taken by the committee. Under the committee's bill, no patient who receives a surprise bill would be obligated to pay more than if they received care by an in-network provider — identical to the protection provided by a previous version of the bill supported by health plans," wrote James L. Madara, MD, CEO and executive vice president of the AMA.
He added that "AHIP’s angst apparently results from the fact that the 'baseball-style' arbitration adopted by the committee … would allow an independent third party to determine whether the plan payment amount or the provider bill represents the most appropriate resolution to the claim."
The No Surprises Act — which addresses bills that occur after patients unknowingly or without a choice receive care from an out-of-network provider — would resolve out-of-network payment disputes between the patient's insurer and provider by establishing rates for payments from commercial health plans to providers based on the health plan's median in-network rates.
The initial No Surprises Act did not include a process for providers and payers to challenge the basic median reimbursement. But on July 17, the Energy and Commerce Committee passed the No Surprises Act, with the addition of third-party arbitration process for resolving certain payment disputes.
In response to the AMA's letter, insurers expressed concerns about arbitration.
"Patients must be protected from surprise medical bills. But using arbitration is no solution. Arbitration means sky-high healthcare costs stay sky-high — resulting in higher premiums for everyone," America's Health Insurance Plans told Becker's via email.
"There is no excuse for specialty doctors who take advantage of medical emergencies to charge several times more than Medicare or market rates. Americans cannot afford to accept out-of-control rates charged by specialty providers as a 'reasonable' starting point. We need a different starting point — appropriate rates that are based on competitive, local market negotiations," the group added.
Read the AMA's full letter here.
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