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June 26, 2019

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Federal legislation can protect patients from surprise medical billing

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Federal legislation can protect patients from surprise medical billing

Surprise medical billing imposes severe hardship on many of the 140 million Americans who receive care in an emergency department each year. This phenomenon has many causes, ranging from insurers’ failure to create adequate provider networks to the fact that high-deductible benefit plans expose patients to high out-of-pocket costs.

Many physician organizations, including my own, have petitioned state legislatures and the U.S. Congress to address surprise medical billing. Several states have recently passed surprise medical billing legislation, and others, including Tennessee, are in the process of doing the same. However, because of the nature of federally-regulated, employer-funded insurance coverage, states cannot effectively regulate this practice, and a federal solution is needed.

Any effective federal legislation to address surprise medical billing should naturally protect patients. It must also include insurer accountability, transparency and reasonable limits on patients’ out-of-pocket costs. Good news is on the horizon. A bi-partisan solution that meets these needs has recently been presented by U.S. Rep. Phil Roe, R-Tenn. Roe, along with U.S. Reps. Raul Ruiz, D-California; Van Taylor, R-Texas; Joseph Morelle, D-New York; Larry Bucshon, R-Indiana; Ami Bera, D-California; Brad Wenstrup, R-Ohio; and Donna Shalala, D-Florida: the Protecting People from Surprise Medical Bills Act.

The key to this bill is a process called Independent Dispute Resolution. IDR protects patients by taking them out of the middle of reimbursement disputes while incentivizing insurers and providers, through an independent third party, to reach a fair, cost-effective and timely resolution of their dispute. Ultimately, the bill encourages arms-length negotiations between the two parties, which in turn promotes sufficient in-network reimbursement. Sufficient reimbursement means that emergency departments across the country can continue to provide critically needed care.

We urge U.S. Sen. Lamar Alexander to support this framework, which addresses surprise medical billing comprehensively, in a way that will not adversely affect Tennessee’s hospitals and emergency medical physicians. While Alexander’s recently released draft bill would protect patients, it would also result in draconian cuts in reimbursement and create emergency physician staffing shortages, particularly in rural and disadvantaged communities.

Congress has a real opportunity to protect Americans by implementing an IDR process at the national level. I encourage Alexander to join with Republicans and Democrats in both the Senate and House in support of the Protecting People from Surprise Medical Bills Act.

Leif Murphy is the chief executive officer of TeamHealth, one of the leading physician practices in the U.S., based in Knoxville. 

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Author: Leif Murphy, Chief Executive Officer of TeamHealth