American Society of Plastic Surgeons
For Consumers

ASPS Continues Fight on Federal Balance Billing Solution

Throughout the 116th Congress, ASPS has led an aggressive advocacy campaign to combat balance billing proposals that unfairly reimburse physicians. As part of these efforts, ASPS has been working with a stakeholder group of physician organizations that are also committed to thwarting attempts on Capitol Hill to tie physician reimbursement for disputed out-of-network payments to median in-network rates.

The coalition has recently focused on sending a clear message to Congress: a pandemic would be the worst possible time to adopt lopsided balance billing legislation because it would further destabilize physician practices and severely limit patients' access to specialty care. ASPS in particular has urged lawmakers to support a proposal that establishes a fair, independent dispute resolution process that reimburses physicians at competitive market rates. While the group has been successful in holding the line on balance billing policy, there has been a renewed congressional push to wrap up the issue by December 31.

The wheels were put into motion for this latest renewed push when President Trump unveiled an Executive Order on surprise medical billing which clarified that the Administration would take action without Congress if a legislative solution is not reached by the end of the year. Shortly after the order, new rumors began circulating on Capitol Hill that a secret balance billing deal was reached by Senate HELP Committee Chairman, Lamar Alexander (R-TN), House Energy and Commerce Committee leaders, Chairman Frank Pallone (D-NJ), Ranking Member Greg Walden (R-OR); and Senator Bill Cassidy, MD. While no text has been publicly released, ASPS believes that the proposal would still recklessly tie reimbursement to the median in-network. This news is concerning because Sen. Cassidy, MD, who had been a key Senate negotiator for physicians on Senator Alexander's proposal, announced in a press release that he was in support of the new agreement.

To address these rumors head-on, the stakeholder group developed a statement that reiterated its long-held balance billing principles and provided the statement to House Ways and Means Committee Chairman Richard Neal, who has been actively working with the physician community towards a deal that would level the playing field for the physicians. The principles were drafted to vocalize concerns with the new Energy and Commerce and HELP Committee proposal and to give Chairman Neal leverage in his ongoing negotiations with congressional leadership. The physician principles were effective in opening up communication between Senators Alexander and Cassidy about the matter, and ASPS will continue to use these opportunities to lobby against this disastrous policy.