February 09, 2018
Physician Anesthesiologist Lawmaker Introduces OON Legislation
On February 5, Oklahoma State Senator Ervin Yen, M.D. (R), a longtime ASA member, introduced Senate Bill 1478, the Clinician Out-of-Network Act. The measure would help patients avoid "surprise" insurance bills through establishing, among other things, a minimum benefit standard with an amount equal to the eightieth (80th) percentile of an independent, nonconflicted database of bill charges. The bill language conforms to the principles agreed to by the ASA led multispecialty group with solutions that keeps patients out of the middle but ensures fair market principles in payment for physicians.
According to Dr. Yen, “The legislation effectively holds insurers accountable for providing an adequate network for all providers and services through, where in those instances that they fail to do so, making them issue payments based on real market values, therefore preventing patients from having to deal with grossly inadequate and surprise coverage.”
Out-of-network payment, also commonly termed “surprise bills” or “balance billing” is a high level issue of concern for ASA, state component societies, large group practice entities, and a growing number of stakeholders including medical specialty organizations, insurers, patients and consumer groups, and others. Out-of-network payment 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. In most cases, balance billing is the result of a large gap between what the insurer chooses to pay and the physician’s billed charge.
In 2017, nearly half the states considered out-of-network legislation. These initiatives ranged from network adequacy requirements to cost estimates delivered to patients prior to procedures to prohibitions against balance billing. ASA’s Department of State Affairs predict that such legislation will continue to be a strong theme in 2018.
To learn more about this important issue, please contact Erin Thompson, ASA State Affairs Associate, at firstname.lastname@example.org.