Urge Legislators to Support Fair out-of-Network Reimbursement Approach

As the end of the legislative session approaches, the Health Care Conference Committee charged with reconciling the House and Senate passed health care bills is in active negotiations.  The time for them to hear the voice of emergency physicians on Out-Of-Network (OON) is now. 

The Senate bill would charge the Health Policy Commission with setting rates of reimbursement in instances where there is no contract between the provider and insurance carrier. The House bill proposes a one-year interim approach allowing the option of reimbursement based on the greater of 115% of the average rate the carrier pays for that service and 135% of Medicare.  MACEP was instrumental in improving the House language with an amendment that was ultimately adopted by the full House prior to passage. 

MACEP strongly supports no action on OON during these unprecedented times.  If the committee chooses to move forward, the House language is the better approach. The current state of emergency and tenuous economic landscape for hospitals and the health care system as a whole lends itself to a cautious, interim approach that will allow for more thoughtful, deliberative discussion over the next year. 

We need your help in communicating this message to House and Senate leadership and key conferees.  The more they hear the voice of emergency physicians, the better chance we have of prevailing.

For your convenience, below is a sample email. Please feel free to modify as you wish. Dear Mr. Speaker, Madam President, Majority Leader Mariano and Madam Chair, As an emergency physician, I am concerned about passing new Out-Of-Network (OON) legislation during this time of uncertainty. Emergency physicians in Massachusetts and across the country continue to bear the brunt of the COVID-19 pandemic. We are already under unusual mental, physical and financial strains from this public health crisis of a lifetime. We are concerned that new legislation on OON billing that impacts us negatively at this time would not be in anyone’s best interest. Despite the infusion of state and federal COVID relief funds, hospital margins continue to decline. Moreover, on both the state and national level, there are several safeguards currently in place to protect patients from OON charges. Every health care provider that accepted federal COVID-19 relief funds have already agreed to eliminate balance billing. On the state level, Governor Baker’s Executive Order prohibiting balance billing is still in place for the duration of the state of emergency, further protecting patients from unexpected OON charges. There has also been much discussion on this issue at the federal level and Massachusetts would not want to be out of sync with that legislation should it move forward. No action at this time may be the best action to take. If conference committee chooses to include OON provisions in the final report, my emergency physician colleagues and I believe the interim approach proposed by the House is the better option. It will protect patients from unexpected bills and ensure fair reimbursement for providers, while MACEP continues to advocate for a permanent solution that includes a fair and independent dispute resolution process. Most importantly, it will allow for further discussion on this issue in the next session, which we all hope will be under more stable and normal circumstances. Thank you Name Hospital affiliation and contact info Enter your information to take action now!


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