Congress considers California's surprise-billing solution

Kelly Gooch - Print  | 

As Congress works on a legislative solution to surprise medical billing, federal policymakers are moving toward an approach similar to California law, according to The New York Times.

California's surprise-billing law, implemented in 2017, addresses unexpected patient bills for out-of-network, nonemergency physician services at in-network hospitals by paying out-of-network health professionals a benchmark, locally negotiated market rate.

"Every single office I'd go into, I would start talking about our experience in California," patient advocate Anthony Wright, who lobbied Congress on the issue, told the newspaper. "And they would stop me and say, yeah, you're the fifth person who has come in to talk to us about that."

The California Medical Association argues that the state's surprise-billing law "is reducing access for patients to in-network physicians and jeopardizing access to on-call physician specialists needed in medical emergencies," according to the NYT.

But the newspaper cites an analysis of state data and a study of insurer claims that suggests that while the law may be hurting reimbursement to some physicians, it's not hurting patients.

"It is possible that there are cases where they are receiving less money for in-network and out-of-network services," Erin Duffy, an adjunct policy researcher at the Rand Corp. who has studied the California law, told the NYT. " While loss aversion is real, I don't think providers are going to be exiting the practice of medicine over this."

Physician and hospital groups have generally been opposed to benchmarking, and instead favor arbitration to resolve out-of-network billing disputes between insurance companies and providers.

Congress has reconvened from the August recess, but has yet to take full votes in either chamber on surprise-billing legislation.

Access the full NYT report here.

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