A nonprofit multispecialty alliance of physicians has released a legislative model for federal lawmakers to consider as they take up surprise medical bills.
Five things to know:
1. Physicians for Fair Coverage's proposal aims to end unanticipated, out-of-network medical bills and protect patients from them.
2. It proposes prohibiting physicians and insurers from balance-billing patients for unanticipated out-of-network care and would keep patients' cost-sharing for unanticipated out-of-network services the same as for in-network services.
3. The proposal also includes a national protocol for alternative dispute resolution, which would be used to resolve reimbursement conflicts between healthcare providers and insurers. The alliance said the proposed alternative dispute resolution model builds on laws successfully implemented in states that ban unanticipated, out-of-network bills and create fair reimbursement standards for providers.
4. Regarding transparency, the proposal calls on insurers to provide patients with "accurate, up-to-date and accessible" online and print clinician directories that are in "easily understood language." The directories, which include information such as how the health plan's network is built and organized, are designed to help patients access information that will help them make care and insurance coverage decisions.
5. The alliance opposes using Medicare standards as a benchmark for setting reimbursement rates for out-of-network care.
Read the alliance's full legislative proposal here.
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