Patients and Physicians Rally to End the Surprise Insurance Gap
January 24 2017 - 12:00AM
Business Wire
In a Capitol Rotunda rally, a coalition of physicians and
patient advocates today endorsed a platform of key guidelines they
say should be included in legislation intended to end balance
billing in the emergency department.
The Medical Association of Georgia (MAG), the Georgia College of
Emergency Physicians (GCEP), and the Epilepsy Foundation of Georgia
are joining forces in a campaign to support legislative efforts
that protect patients from unexpected gaps in insurance coverage
that can lead to surprise medical bills in emergency care -- care
insurance companies refuse to cover. More organizations are
expected to join the campaign in the coming days.
The campaign includes a video designed to highlight the problem,
statewide advertising, a robust social media movement, and an
advocacy blitz by the organizations to urge their members to
contact their representatives to voice support for the following
guidelines to end the surprise insurance gap:
- The patient should be held financially
harmless for unexpected Out-Of-Network (OON) care.
- Any patient deductibles and
cost-sharing for unexpected OON care should be applied to
in-network rates.
- An appropriate and fair standard should
be created for out-of-network services that establishes a
charge-based reimbursement schedule (meaning 80th percentile)
connected to an independently recognized and verified
database.
- Physicians would no longer submit
balance bills to patients for services rendered.
- Greater transparency should be required
of insurers. Specifically,
- network provider directories should be
easily accessible for both patients and physicians, updated
immediately and completely accurate, and
- patients should have access to
information on the average charge, reimbursement rate, and expected
out-of-pocket costs for any health care service or procedure in all
geozips.
- Insurance carriers should be prevented
from providing false, misleading and/or confusing information in
regards to coverage.
“Insurers are narrowing their physician networks to shift costs
onto the backs of patients and physicians,” said Steve M. Walsh,
MD, President, Medical Association of Georgia. “In the event of an
emergency, health insurance companies shifting costs is more
insidious. Knowing that hospitals are required by federal law to
provide emergency care for all patients, regardless of their
ability to pay, insurers are forcing physicians out-of-network –
even at hospitals within their networks. The result is a surprise
insurance gap that is creating financial hardship for too many
patients and eroding the doctor-patient relationship.”
The Epilepsy Foundation of Georgia said the organization is
supporting the guidelines because they hold patients harmless for
medical costs insurers should cover. Each organization indicated
ending the surprise insurance gap was a top priority for this
legislative session.
“What good is insurance coverage if it abandons you in an
emergency?” asked Aly Clift, Executive Director, Epilepsy
Foundation of Georgia. “Insurance companies need to hold up their
end of the bargain and be there when patients need care most.”
The coalition said the insurance company lobby has pushed for a
ban on balance billing, but their proposals would do nothing to
solve the problem. In fact, a ban on balance billing with no
transparency, no improvement on patient protections, and no
mechanism for fair reimbursement for physicians would put up
barriers for patients to access emergency care, especially in rural
Georgia. It would end up leaving physicians with reimbursements far
below the cost of providing life-saving services.
“Our patients need surprise insurance gap protections and
physicians need to be adequately paid for their services,” said
Matt Keadey, MD, President-Elect, Georgia College of Emergency
Physicians. “The guidelines we think need to be in any legislation
addressing surprise billing do just that by removing patients from
any physician-insurer payment disputes and requiring a floor for
out-of-network reimbursements at in-network facilities. These
guidelines are a step in the right direction to fix a problem that
has impacted too many Georgians.”
The groups represented here believe that an appropriate and fair
reimbursement standard for out-of-network services should be
determined using a database of medical service prices (or charges)
in a geographic area that is maintained by an independent
non-profit organization not affiliated or financially supported by
an insurance carrier.
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Physicians for Fair CoverageMichele Kimball,
703-610-0208President and CEOmkimball@thepfc.org