American Society of Plastic Surgeons
For Consumers

ASPS Fights Balance Billing Changes in COVID Legislation

In the weeks before the pandemic, the last congressional committees with jurisdiction over out-of-network (OON) billing passed separate legislative packages to deal with the problem. It appeared these packages would be blended before a May 22 deadline to produce a final bill, and organized medicine worked aggressively to secure more time to negotiate an equitable solution. Every bill produced by the leading committees in Congress projected to drive out-of-network and in-network rates down, handing insurers a windfall in reduced physician payments and saving the government around $20 billion.

Then the public health emergency hit, and its financial damage to health care providers was so severe that most observers believed OON legislation would be addressed only after the effects of a shutdown were known. A crisis that demanded tens of billions of dollars in direct financial support for physicians was not the time, the logic went, to pass legislation that would further reduce their bottom lines. However, reports surfaced as the CARES Act took shape that key committee leaders were pushing to include OON legislation in the stimulus measure (which contained those billions of dollars to help physicians stay afloat while not practicing due to statewide shutdowns).

This trend has continued throughout the pandemic. Rep. Greg Walden (R-OR-02) and Sen. Lamar Alexander (R-TN), both retiring members of Congress and central players in the OON debate, continue to publicly endorse including harmful balance billing policy in COVID-19 response measures. Additionally, the White House has tried to wrap a surprise billing solution into pandemic response, floating the concept of a blanket ban on balance billing and no formal out-of-network payment resolution system.

Throughout these misguided efforts, ASPS has used a variety of means to push back. Staff-level meetings with the congressional committees that developed the CARES Act included pointed talk about the damage an imbalanced OON solution would have on the post-pandemic practice environment. These face-to-face Zoom conversations continue, and both ASPS and PlastyPAC have made keeping non-COVID balance billing out of COVID legislation a priority in nearly two-dozen meetings with members of Congress or their staff.

As Congress heads toward its August recess and the campaign trail, work toward another, likely final emergency response package has gained steam in the last six weeks. With that momentum, the potential inclusion of OON policy in a response package persists. ASPS has, in that time, contacted congressional leadership and the White House to push back. This work will continue until OON billing is again considered through the regular legislative process, but you should be prepared to mobilize in the short-term if balance billing provisions are included in a COVID-related package. There is a good chance that such a provision would be among the most impactful parts of such a bill for plastic surgeons, and that will warrant a proportional outcry against it.