On Tuesday, January 19, longtime ASA physician leader, Gary Friedman, M.D., testified on behalf of the New Hampshire Society of Anesthesiologists in opposition to introduced legislation (OR HB 1516) that would, among other things, prohibit balance billing by out-of-network providers who provide services at in-network facilities. In most cases, balance billing occurs when a patient receives a bill for the amount remaining between the out-of-network provider’s fee and the amount contributed by the patient’s insurer after copay and deductibles. Recent legislative efforts have ranged from prohibitions on balance billing to requirements for “good faith estimates” to out-of-network disclosure/consent requirements for non-emergency services, to mediation triggered by a minimum price threshold.
Per Dr. Friedman, “My anesthesia group gave me the day off from the OR to travel to our state capital to give testimony. We heard testimony from the State Insurance Commissioner, Blue Cross/Blue Shield, The American Health Insurance Plans Association (AHIP), the Hospital Association, the NH Medical Society, a retired Pathologist, a Dartmouth Hitchcock representative, a constituent/patient impacted by out of network balanced billing issues, and me. I was the only actively practicing physician in the room.”
The focus of concern with balance billing is often with those facility-based providers patients assumed would be covered similar to their in-network surgeon and hospital.
Unfortunately, efforts to prohibit balance billing are often viewed by physicians as focusing on the wrong part of the issue. Focusing on “surprise bills” as opposed to adequate networks keeps patients and the public from demanding that insurers have networks with an appropriate number of providers as opposed to the inadequate narrow networks insurers have developed.
A primary take-away from Dr. Friedman’s experience was “…the focus has erroneously been placed on hospital-based physicians, so it would have been nice to have had representation from Radiology and Emergency Medicine, as well as any other group or individual that regularly bills as out of network.”
A big thank you goes out to Dr. Friedman and the countless physician leaders across the country taking time away from their patients, their practices, and their families to advocate on behalf of patient safety and the profession. Dr. Friedman learned firsthand how critical participation is at the state level. Had he not participated, lawmakers may not have learned the true impact of the introduced measure. Participation is crucial.
If called upon to testify at your state legislature, or to learn more about getting involved with your state’s legislative advocacy initiatives, please feel free to contact the State Affairs team for resources and related assistance.
Jason Hansen, Director of State Affairs – firstname.lastname@example.org
Erin Philp, Senior State Affairs Associate – email@example.com
Ashli Eastwood, State Affairs Associate – firstname.lastname@example.org