Posted July 15, 2019
Last week, KMA leaders traveled to Washington, DC to meet with members of Kentucky’s congressional delegation regarding legislation related to out-of-network or “surprise” billing.
KMA Secretary-Treasurer Bob Couch, MD, along with KMA Executive Vice President Pat Padgett and KMA Deputy Executive Vice President/Director of Advocacy Cory Meadows met with both Kentucky Senators and its six Representatives. The meetings were well-received and came at a crucial time for the legislation, as discussion has continued to intensify.
KMA is urging members to help further this work by contacting House and Senate members to request that the patient be removed from out-of-network billing disputes and to implement a New York style arbitration policy that supports access to care and fairness between health plans, providers and patients.
Members are encouraged to utilize the following talking points in their outreach:
- The Kentucky Medical Association agrees fully with efforts to protect patients from the financial impact of unanticipated medical bills.
- While the principal Senate and House bills adhere to this principle, these measures would only require insurers to pay the physician at the plan-specific median in-network rate. A government-mandated payment benchmark such as this is an untested formula that will harm physicians and patients alike.
- Instead, when the minimum payment from the payer for out-of-network care is insufficient, an independent dispute resolution (IDR) process, similar to a New York State law, should be developed to determine a fair payment by the health insurance company for the care provided.
- The IDR should be structured with clear factors that an arbiter, familiar with health care billing, must consider when deciding such as the complexity of the case, the experience of the physician, and the rate that physicians charge for that service in the area.
- Fair and reasonable payment should be based on actual local charges as determined through an independent claims database.
- To protect patients from the failure of their health insurer to provide an adequate network of physicians, any federal bill should include strong and enforceable network adequacy requirements based on measurable standards. Such requirements will prevent surprise bills before they happen.
- Benefits should be assigned to the physician or other providers so that they may pursue payment for services provided directly with the insurer without further involving the patient.
Contact Senator McConnell (202) 224-2541
Contact Senator Paul (202) 224-4343
Contact Congressman Comer – 1st District (202) 225-3115
Contact Congressman Guthrie – 2nd District (202) 225-3501
Contact Congressman Yarmuth – 3rd District (202) 225-5401
Contact Congressman Massie – 4th District (202) 225-3465
Contact Congressman Rogers – 5th District (202) 225-4601
Contact Congressman Barr – 6th District (202) 225-4706