American Society of Plastic Surgeons
For Consumers

ASPS, State Societies Advocate Fair OON Reimbursement

Three states that witnessed contentious 2018 out-of-network battles have again introduced bills during the new 2019 legislative session. Those bills vary from an egregious power grab by the insurance industry in Connecticut and Washington to a model bill in Georgia that would ensure physicians see fair reimbursement for out-of-network emergency services.

Connecticut Senate Bill 905 would remove necessary patient protections that are currently in place. Repeal of those protections – for both patients and physicians – would allow insurers to determine reimbursement rates and remove transparency from the existing fee schedule. ASPS sent comments opposing the bill to the Connecticut Joint Committee on Insurance and Real Estate. In addition to those comments, ASPS collaborate with the Connecticut Society of Plastic Surgeons to put together a factsheet for a coalition of other stakeholders, including emergency physicians, pathology, anesthesiology and others, which was used during lobbying efforts in Hartford. The bill awaits further consideration in the Joint Insurance and Real Estate Committee.

Equally concerning is fast-moving legislation in Washington, House Bill 1065, which would incorporate Medicare rates and median billed charges in the criteria to be considered during payment dispute resolution for out-of-network emergency care. From the start, ASPS collaborated with the Washington State Medical Association (WSMA) and provided critical feedback that influenced WSMA's requested amendments. ASPS joined the Washington Society of Plastic Surgeons (WSPS) in asking the Washington House Appropriations Committee to amend the bill to ensure adequate transparency and patient notifications, provide for fair and timely payment to physicians and avoid arbitration. Unfortunately, those requests were ignored. ASPS and WSPS submitted similar comments to the state Senate Health & Long Term Care Committee, which held a hearing on the bill in late March. The bill currently awaits further consideration by the full Senate, where ASPS, WSPS and WSMA will continue to advocate for amendments to the bill.

While Connecticut and Washington are both facing tougher scenarios, physicians are faring better in the legislative push for fair out-of-network reimbursement in Georgia. The peach state has been one of the most active states when it comes to out-of-network legislation over the past several sessions and this year has not been any different. The Medical Association of Georgia (MAG) again introduced its model legislation, Senate Bill 56, which would provide a comprehensive solution to the surprise billing issue by providing patients with important protections and ensure that physicians are reimbursed fairly for out-of-network services. In what has become a yearly maneuver, the chairman of the Georgia House Insurance Committee introduced a watered-down version of the legislation, H.B. 84, which would only provide for certain patient notification provisions. ASPS worked with the Georgia Society of Plastic Surgeons (GSPS) to submit comments in support of S.B. 56 to the House Insurance Committee, which heard the bill earlier this month, and the societies also alerted Georgia-based ASPS members to contact their state representatives in both houses to urge them to support S.B. 56 and oppose H.B. 84. H.B. 84 failed to pass the House prior to the state's legislative crossover deadline, while S.B. 56 awaits further consideration in the House Insurance Committee.