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Surprise or Unanticipated Medical Bills

Bipartisan Congressional Efforts to Address “surprise billing” for Services Continue to Gain Momentum

The AAO-HNS is very concerned about the impact of surprise or unanticipated medical bills on our patients. The Academy supports a commonsense legislative solution to the problem of surprise billing which includes the following four core principles:

  • Protects patients from out-of-network billing and preserves patient access to hospital-based care.
  • Requires insurer accountability to ensure network adequacy, as well as transparency about out-of-network providers and costs for scheduled care.
  • Establishes benchmark rates that are fair to all stakeholders in the private market; these rates should include actual local charges as determined through an independent claims database.
  • Establishes a fair and independent dispute resolution (IDR) process to resolve disputes about payments from insurers to unaffiliated providers for services rendered out of network to their beneficiaries.

We are pleased that many of the legislative proposals introduced in Congress thus far seek to remove patients from post care billing disputes and increase hospital and insurer accountability. However, we oppose those which tie physician reimbursement to a benchmark such as Medicare or an insurer’s in-network contracted rate. Doing so would potentially lead to the unilateral devaluation of physician services by eliminating negotiating ability with private insurers. Network fee schedules affect all medical and surgical services, not just hospital and emergency care. A significant reduction can result in an inability to keep pace with technical advances and decrease overall access to services.