TMA Pushes to End Surprise Bills – The Right Way
By Steve Levine


Earlier this year, the Texas Medical Association stood firm against an insurance industry power grab presented in the Texas Legislature as a cure for the scourge of surprise medical bills. The same story line is now playing out in the U.S. Congress, and TMA is taking the fight to Washington. 

Along with teams from other state and specialty medical societies, the Physicians Advocacy Institute (PAI), and the American Medical Association, TMA’s chief lobbyist is working Capitol Hill this week to pass a bill that spares patients the pain of surprise bills but doesn’t give health insurance companies complete control over what it pays physicians who treat patients out of network. 

All of the competing approaches would take most patients “out of the middle” of out-of-network billing disputes between insurance companies and physicians, hospitals, and other health care professionals. One version – similar in design to a New York law in effect since 2015, and to the final product the Texas Legislature approved in May – uses “baseball-style” arbitration to resolve the billing disputes. The other variety – modeled after a law California enacted in 2016 – pays physicians based on a “median in-network rate” determined solely by the insurance company, or 125% of Medicare. 

“If indeed, the American states are the laboratories of democracy, the evidence is clear,” TMA wrote in a handout that VP for Advocacy Darren Whitehurst is distributing to federal lawmakers and their staffs. “The New York model, as embodied in the Protecting People from Surprise Medical Bills Act, by Reps. Raul Ruiz (D-Calif.) and Phil Roe, MD (R-Tenn.), is an experiment that worked.” 

U.S. House and Senate committees have begun reviewing, and voting on, surprise billing legislation. A key House committee hearing is scheduled for today, and Mr. Whitehurst is lobbying for that panel to adopt the New York approach. 

“The New York arbitration approach has not only drastically reduced consumer complaints about surprise bills and paid physicians fairly for the care they provide,” he said. “It also addresses the root cause of surprise bills by incentivizing the insurance companies to maintain more adequate physician and hospital networks.” 

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Last Updated On

July 10, 2019

Originally Published On

July 10, 2019

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