TMA Opposes Congress’ So-Called Compromise on Balance Billing

December 11, 2019


Congress has announced a “compromise” this week on a bipartisan proposal to address the issue of surprise medical billing, but TMA and other physician advocacy groups are strongly opposed to the so-called solution that, if signed into law, will be disastrous for physicians and patients.

The late addition of an independent review process, consistently espoused by TMA and organized medicine, is marred by other factors such as a $750 threshold, a 90-day ban on arbitration with the same health insurance plan, and insufficient benchmarks consideration for the arbitrator. If the compromise bill passes, health insurance companies will only be required to initially reimburse out-of-network physicians the market-based median in-network negotiated rate.

The biggest sticking point for physicians throughout the negotiations is that Congress could allow insurance companies to effectively set the payment rates for out-of-network services. TMA has worked with the American Medical Association, Physicians Advocacy Institute and national specialty societies to explain to lawmakers how such a measure would incentivize health insurance companies to cut their own costs (i.e. increase their own profits) by eliminating providers with highest rates and drive down the median, or average, to as close to zero as possible.

The “compromise” bill touted by Congressional leaders this week in no way addresses the root cause of balance billing – health plans’ narrow networks.

TMA has engaged Tennessee’s congressional delegation since discussions began in Washington several months ago to ensure that federal legislation on unexpected out-of-network medical bills contains these core 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. The compromise keeps patients out of the middle but in no way offers fair compensation for physicians who provide out-of-network services or a level playing field to negotiate reimbursement.

  • Hold health plans accountable to patients with reasonable network adequacy standards. The compromise fails. There are no measures to hold plans responsible to minimum standards for having enough providers in network to afford patients choice.

  • Do not allow insurance companies to set their own reimbursement rates without negotiating with physicians and other healthcare providers. If plans can drive rates lower, soon all providers will be out of network.

  • Create a fair arbitration process to resolve payment disputes between providers and payers, and keep the patient out of it. The compromise includes such a measure but neuters it with insurance-friendly provisions.

TMA, AMA and the vast majority of organized medicine groups have and continue to back The Protecting People from Surprise Medical Bills Act, sponsored by Reps. Raul Ruiz (D-Calif.) and Phil Roe, MD (R-Tenn.). TMA urges members to contact their elected officials in the Senate and House of Representatives immediately and let them know the so-called compromise does not go far enough to protect patients and physicians. Ask them to reject the compromise and instead support H.R. 3502.

Read more about TMA’s advocacy on this issue at tnmed.org/balancebilling.