TMA Meets with Congressmen on Surprise Medical Billing

June 26, 2019

The Tennessee Medical Association has been engaging lawmakers in Washington this week on proposals to address surprise medical bills. 

TMA leaders traveled to Washington, DC to relay physicians’ concerns to Tennessee Senator Lamar Alexander about surprise billing provisions in
a broader legislative package called the Lower Health Care Costs Act of 2019. The proposal would hold patients harmless but would allow health insurance companies to set their own median reimbursement rates for out-of-network services. Doctors told Sen. Alexander that aspects of the bill would cause more physicians to be cut from health plan networks, create access issues, and ultimately increase costs for patients. 

“We understand what Senator Alexander is proposing about the median rate,” said Russ Miller, TMA CEO. “We suggested that this rate be a first payment on out of network services and that there be an additional independent dispute resolution process to serve as a backstop when the physician feels the fee should be challenged.”  

On the House side, Tennessee Congressman and TMA member Phil Roe, MD (R-TN) has sponsored the Protecting People from Surprise Medical Bills Act along with Rep. Raul Ruiz, M.D. (D-CA). The House bill would free patients from the financial burden of surprise medical bills by allowing them to pay no more for out-of-network treatment than they would had the care been provided in-network. The bill also provides a simple and fair payment dispute resolution process that does not involve the patient, and leaves flexibility for Tennessee and other states to address surprise billing at the state level. 

T
he Senate bill sponsors sent a press release earlier this week touting support from the insurance and labor industries, but the Physicians Advocacy Institute and others have recently announced their opposition to the bill. TMA is working with PAI, the American Medical Assocation and others to coordinate physicians’ advocacy on the issue. 

All bill sponsors in the House and Senate seem to agree that any solution(s) should hold patients harmless. 

TMA has worked on balance billing for a number of years at the state level, repeatedly pointing to health plans’ narrow networks as the root cause of balance billing. Insurance companies allow fewer providers in health plan networks as a way to cut costs but the patients pay the price in the form of surprise medical bills.

TMA’s core principles on any federal or state legislation addressing balance billing are:

  • 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.

Next Steps
The Senate bill moved out of the Health, Education, Labor and Pensions Committee today and we anticipate a three- to four-week process for the package to move to the Senate Floor, during which time it will likely undergo several amendments.

We will keep member abreast of progress and will call on Tennessee physicians to contact their Congressmen as the proposals advance with amendments in both chambers in the coming days and weeks.