In a letter to leaders of the U.S. Senate and House of Representatives, ASCO, along with more than 100 other medical groups, urged Congress to protect patients from unanticipated, or “surprise,” medical bills that can occur when gaps in health insurance coverage lead them to receive care from out-of-network providers.
The letter asserts that patients should be held harmless for any costs above their in-network cost-sharing where a coverage gap occurs and patients, unknowingly or without a choice, receive care from an out-of-network provider. Patient cost-sharing, according to the letter, should count toward deductibles and out-of-pocket maximums. The letter adds that patients should be completely removed from any subsequent payment disputes between their health insurance company and an out-of-network provider when they experience an unanticipated coverage gap.
The letter cites evidence that a balanced approach would achieve the goal of protecting patients from surprise bills while maintaining their access to care in more competitive markets. Such a balanced approach would include timely and reasonable payment for out-of-network services and an efficient independent dispute resolution (IDR) process that incentivizes health insurers to make a fair initial offer to pay for out-of-network care provided to their customers—while also preventing bills from physicians or other providers that are outside generally acceptable reimbursement ranges.
In July 2019, the House Energy and Commerce Committee took a critical legislative step forward by adopting an IDR process in the “No Surprises Act,” which aims to protect patients from surprise medical bills. The letter outlines key recommendations to help ensure that the legislation is fair and market-focused, while retaining strong patient protections and preserving the viability of physician practices.
A balanced solution to surprise billing, according to the letter, also requires that insurers be held accountable for addressing their own contributions to the problem. Any surprise billing legislation should also establish strong, measurable, and enforceable network adequacy requirements to ensure that insurers maintain adequate provider networks and do not force patients out-of-network to access needed care.
ASCO will continue to work with Congress to ensure that surprise billing legislation represents a fair, market-based approach that treats stakeholders equally while protecting patient access to care.
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