American Society of Plastic Surgeons
For Consumers

ASPS Continues Fight Against Devastating Out-of-Network Billing Proposals

The July edition of Advocacy Matters featured an update on efforts in Congress to pass out-of-network (OON) billing legislation. Congress has been focusing on an approach that would drive both out-of-network and in-network rates down, ultimately saving the government roughly $20 billion. These attempts at tying physician reimbursement to the in-network rate represent government rate-setting and were met with significant opposition from ASPS and PlastyPAC, which both prioritized preventing the policy from being included in the next COVID-19 response package.

In the weeks since the July update, ASPS has continued to aggressively oppose OON billing legislation. A grassroots alert to U.S. members resulted in calls to members of Congress, urging them to sign on to a letter to their colleagues on the House Energy and Commerce; House Education and Labor; and Senate Health, Education, Labor, and Pensions (HELP) Committees opposing the inclusion of balance billing policy in COVID-19 relief legislation. ASPS also co-signed an AMA letter to congressional leaders urging them to not "adopt divisive surprise billing legislation."

On August 7, ASPS sent a letter to a group of six committee leaders who are claiming to have a "bipartisan, bicameral" agreement to address OON billing. The letter expressed opposition to the type of OON billing proposals that negotiators have been trying to push in Congress, like the deal announced by the six legislators, that tie reimbursement to the median in-network rate. In the letter, ASPS characterized the legislation as, "anti-competitive and an outrageous gift to the for-profit insurance industry," and called for due process and careful deliberation over a fast-tracked policy that would cut "physician reimbursement – for both out-of-network and contracted care – by a projected $50 billion" per year.

The letter was signed by 393 plastic surgeons representing 40 states who responded to a July 31 grassroots alert. This tremendous response and participation by ASPS members was critical in conveying the devastating impact of OON billing proposals in the midst of a public health emergency and financial crisis. A focused social media campaign on Facebook and Twitter also helped ASPS inform and engage members on both the call and letter campaigns.

As Congress works toward consensus on the next COVID-19 relief package, the Society will continue to strongly oppose any efforts to include and pass balance billing policy tied to the median in-network rate.