SB0001 / HB0002
Balance billing is one of TMA’s top legislative priorities in 2021. TMA has worked with Sen. Bo Watson and Rep. Robin Smith to file bill SB0001 / HB0002, which closely mirrors legislation that was passed at the federal level.
WHY THE BILL IS NEEDED
Physicians and other healthcare providers sign contracts to be in health insurance plans’ networks. Since the passage of the Affordable Care Act, some health insurance companies have decided to cut costs (and increase profits) by creating “narrow networks” by contracting with fewer healthcare providers who extend preferential reimbursement rates to those in their network.
While most hospital-based providers want to be in network, the health insurance plans often deny those contracts or offer unacceptably low reimbursement rates. Some patients who schedule care at an in-network hospital may receive services from out-of-network providers as part of the same visit. Patients cannot choose everyone involved in their care team (e.g. radiologists, anesthesiologist, emergency physicians or pathologists, etc.)
Out-of-network physicians have a right to be reimbursed for their services and are left to bill patients directly for the higher out-of-network charges. Patients get caught in the middle when health insurance plans do not pay the out of network provider’s entire bill and so they receive “surprise medical bills” for the balance amount not paid by insurance.
TMA wants a reasonable solution that shares the burden between providers and insurers, but frees patients from balance and surprise bills for out-of-network care. The federal legislation only applies to those Tennesseans’ enrolled in E.R.I.S.A plans. Therefore, a state solution for Tennesseans’ in the private non-E.R.I.S.A. market and uninsured needs to be implemented. It is important to maintain continuity with the federal solution while making sure that all Tennesseans can be held harmless from surprise or balance medical bills that are no fault of their own.