MMA Advocates for More Physician-Friendly Approach to Surprise Billing Legislation

7/11/2019
The MMA sent letters to the Minnesota Congressional delegation on July 2 urging lawmakers to consider a more physician-friendly approach to potential “surprise billing” legislation. 

Congress is considering several proposals that address surprise billing by mandating that when a patient receives unanticipated out-of-network care, the patient’s insurance will pay the physician at the median in-network rate. 

The MMA believes that negotiated, in-network rates should not be used as a benchmark to determine fair payment to out-of-network physicians. Establishing such a benchmark incentivizes insurance companies to reduce rates paid to physicians or eliminate physicians with contracts above the median rate.

“The MMA applauds efforts to protect patients from the financial impact of unanticipated medical bills that arise when a patient receives care from an out-of-network physician or facility,” says the letter signed by MMA President Doug Wood, MD. “The MMA cautions that any legislation that mandates a median in-network payment rate has the potential to reduce physicians’ ability to negotiate fair contracts with payers.”

Instead, the MMA supports an independent dispute resolution process, often referred to as “baseball-style” arbitration. “This is a fair and balanced model that can reconcile differences between physician charges and plan payments while at the same time protecting patients by removing them from the dispute resolution process,” the letter says.

This “baseball-style” has been successfully implemented in New York. Under the model, the insurer and the physician each make their case for a fair payment rate to an arbiter, who chooses the payment they deem to be the fairest.

The MMA sent out an Action Alert on July 10 urging members to contact their senators and representative and ask them to support the more physician-friendly approach. If you have not done so, find more information here