Surprise Medical Billing

Special interest groups have pushed the Tennessee General Assembly during the past few years to address the issue of “surprise medical bills,” including filing a bill to remove the state’s ban on the corporate practice of medicine. TMA wants to reach a solution – at the state or federal level – that frees patients from the financial burden of unexpected out-of-network charges while protecting physicians’ rights to choose how they practice and get paid appropriately for services they provide.

OUR PRINCIPLES

  • Hold patients harmless for out-of-network charges without removing Tennessee's ban on the corporate practice of medicine, prohibiting balance billing or obstructing physicians' right to be fairly compensated for the services they provide.

  • Hold health plans accountable to patients with reasonable network adequacy standards.

  • Do not allow insurance companies to set their own reimbursement rates without negotiating with physicians and other healthcare providers.

  • Create a fair arbitration process to resolve payment disputes between providers and payers, and keep the patient out of it.


STATE ADVOCACY

While no related bills gained traction in the Tennessee General Assembly during the 2019 session, TMA continued to proactively engage other stakeholders, including insurance companies and hospitals, in efforts to reach a solution that is fair to all parties, especially physicians and patients.

TMA continues to educate state lawmakers on health plans’ narrow networks as the root cause of balance billing and advocate for physicians’ rights to be compensated fairly for the services they provide.

FEDERAL ADVOCACY

Congress in summer 2019 began considering multiple proposals to protect patients from surprise medical bills. While legislators in both chambers agree that the first priority is protecting patients from unexpected charges for out-of-network care, some of the proposed legislation would amount to price fixing, more leverage for insurance companies and more heavy-handed government interference in the delivery of care.

  • H.R. 3502, the Protecting People from Surprise Medical Bills Act, co-sponsored by Rep. Phil Roe, MD of Tennessee, is modeled after a successful law in New York and offers the most promising framework for a positive solution. The bill was referred on June 26 to several House committees.

  • The “No Surprises Act” currently proposed by the House Energy and Commerce Committee is modeled after a failing California law and would harm physicians without addressing the root cause of balance billing. Sponsors recently added a provision for an appeals process, but TMA has concerns about other provisions that would be unfavorable to physicians. It passed out of subcommittee on July 11 and is under consideration by the House Energy and Commerce Committee.

  • S. 1895, the Lower Health Care Costs Act is co-sponsored by Tennessee Senator Lamar Alexander. TMA leaders visited with Sen. Alexander in June 2019 to express concerns over aspects of the bill that would cause more physicians to be cut from health plan networks, create access issues, and ultimately increase costs for patients. A similar model law is failing in California. The bill passed out of the Senate Health, Education, Labor and Pensions Committee and is on the Senate legislative calendar.

TMA is working with the American Medical Association, Physicians Advocacy Institute and state and national medical specialty societies to send a uniform message to lawmakers and make sure that Tennessee physicians have a voice in federal policies affecting healthcare in Tennessee. Learn more about what you can do