Patient Support & Advocacy

Surprise billing: 4 points to raise with your reps during recess

Congress is out of session for all of August, but it is a busy time for senators and representatives as they hold town halls and do other work back in their home districts. American physicians should know about the consequential legislation that has advanced on surprise medical bills and keep four key points in mind when raising the issue with their elected representatives in Congress during the August recess.

Subscribe to AMA Advocacy Update

Stay current on the latest on the issues impacting physicians, patients and the health care environment with the AMA’s Advocacy Update Newsletter. 

Sign Up Now

Physicians and others agree on this central tenet: Patients should be held harmless and not subject to bills higher than they would expect to pay had an in-network physician been available.

Here are four other key points to make with your congressional representatives. Legislation on surprise medical bills should:

  • Establish benchmark rates that are fair to all stakeholders in the private market; benchmark rates should include actual local charges as determined through an independent claims database.
  • Establish a fair and independent dispute-resolution process to resolve disputes about payments from insurers to unaffiliated providers for services rendered out of network to their beneficiaries.
  • Protect patients from out-of-network billing and preserve patient access to hospital-based care by holding insurers accountable for addressing their own contributions to the problem.
  • Require insurers to give patients a robust choice of physicians, including hospital-based emergency physicians, and on-call surgeons and anesthesiologists, who will be there for patients in life and death emergencies.

To learn more, read the AMA Physician Grassroots Network’s (PGN) surprise billing action kit. Use the PGN congressional directory to connect with your legislators’ district office or visit Town Hall Project to easily find when your member of Congress will be holding a town hall or constituent event near you.

If you can’t get to a district event, take a moment to write your members of Congress about this important issue.

Related Coverage

Insurers are a roadblock to proven reforms on surprise medical bills

In late July, the House Energy & Commerce Committee reported out H.R. 3630, the “No Surprises Act,” legislation designed to protect patients from unanticipated medical bills for services provided by out-of-network physicians and facilities in emergencies and other situations where they had no opportunity to choose an in-network provider. The committee’s action follows similar steps taken by the Senate Health, Education, Labor and Pensions Committee.

The AMA has expressed concerns about the bill because of provisions that would resolve payment disputes between physicians and insurers by setting out-of-network payments at the median amount each insurer pays for in-network care.

The willingness of the committee to vote in favor of adding an appeals process, albeit imperfect, represents progress.

Subscribe for free to AMA Advocacy Update, a biweekly newsletter that covers issues affecting physicians, patients and the health care environment. Sign up now.