The American Medical Association (AMA), along with more than 120 state and national medical specialty organizations, agrees that patients who have no opportunity to select an in-network physician should be protected from any charges above what they would have paid in-network.

The “Lower Health Costs Act” released Wednesday by the Senate Health, Education, Labor and Pensions Committee, however, would establish a government-mandated rate that absolves plans of one of their most basic obligations – developing adequate networks of physicians to care for their premium-paying customers.

Under the bill, out-of-network emergency care as well as care from physicians who could not be chosen in advance – such as anesthesiologists, radiologists, pathologists, on-call specialists, and other similarly situated physicians – would be paid at the median in-network rate. That approach would eliminate incentives for plans to contract – and likely encourage plans to drop contracts – with providers who are currently above that amount. 

The AMA believes that proven models, such as in New York, whereby patients are protected and physicians and plans reach a fair agreement through an independent dispute resolution mechanism offer a superior pathway that treats all parties fairly.

Media Contact:

Jack Deutsch

ph: (202) 789-7442

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About the American Medical Association

The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care.  The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.

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