News & Media
Surprise, Out-of-Network Billing: More Leverage for Health Plans
With Thanksgiving break in the rearview mirror, lawmakers are back in Lansing making one final push before the New Year.
It’s a busy time and the Michigan State Medical Society anticipates movement on a few bills that could impact Michigan’s physicians and the patients they serve—specifically, Senate Bills 570 and 572, legislation that seeks to address the problem of surprise out-of-network (OON) billing. Similar legislation has been introduced in the House – House Bills 4459 and 4460 – however, no further action is anticipated until the new year.
The issue at hand relates to cases when Michigan patients receive emergency care or care delivered by an OON provider when the patient did not have the ability to choose his or her provider or the only provider available to treat was OON. It’s happening, in part, because insurance companies continue to shrink their networks, limiting choice while simultaneously shifting hundreds of millions of dollars in medical costs to patients each year.
This is a problem that should be resolved between insurance companies and providers and Michigan patients should not be caught in the middle. However, these bills are far from the solution.
In fact, by relying solely on price-setting measures, these bills would only make things worse for patients by further limiting choice and constraining health care options. And in addition to implementing rigorous fee schedules, the proposed bill package includes no provisions for a physician to appeal a payment, nor any provisions to ensure network adequacy or health benefit transparency.
In other words, it’s legislation that puts its full weight behind the insurance industry instead of behind the patient where it belongs.
The measures are currently pending before the Senate Insurance and Banking and the Michigan House Ways and Means committees and they need critical changes before they advance.
If you haven’t already, please take a moment to urge the Senate Insurance and Banking Committee members to reject this bill package, as written. Without amendatory changes that allow physicians to appeal a payment and other patient protections regarding network adequacy, the bills are far from the fix Michigan patients need. It’s important that they hear from you on this: http://MSMS.org/OON.
Michigan patients deserve—and need—a solution to the surprise billing problem that puts them first, and this bill package certainly isn’t it.