ASCP Continues Patient Advocacy Efforts on Surprise Billing Legislation

Publication Date: Nov 12, 2019

On October 16, ASCP, along with 61 national medical associations and 49 state groups, sent two letters to Congressional leaders (one addressed to House leadership and one to Senate leadership concerning current legislative approaches for addressing the issue of surprise medical bills.The letters, developed by the American Medical Association (AMA), include recommendations for ensuring patient protections against unexpected coverage gaps while maintaining adequate, reasonable payments for physicians such as pathologists.

Specifically, the letters request that the monetary threshold triggering an Independent Dispute Resolution (IDR) process be lowered from the current $1,250 figure, as it is too high to ensure adequate reimbursement for services that fall below this threshold. The IDR process protects patients from billing disputes, so it is a favorable process, but in order to protect even more patients, the monetary threshold should be lowered.

Further, the letters urge that the legislative provisions for the initial payment of a median in-network rate should be changed to reflect a commercially reasonable rate that is fair to all stakeholders in the private market and should include actual local charges as determined through an independent claims database.

Finally, the letters request that Congressional members consider a more balanced approach that requires insurers to be held accountable for addressing network adequacy requirements as well as adequate provider networks to ensure patient access to care.

ASCP will continue to work with Congress and the AMA to ensure legislation on surprise billing is fair, market-based, and most importantly, protects patients and their access to care.

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