American Society of Plastic Surgeons
For Consumers

Congress: Improve Federal OON Proposal

Following a nationwide push and a myriad of news stories on out-of-network billing, Sen. Bill Cassidy, MD, and the bipartisan Senate healthcare price transparency working group released draft legislation that targets the occurrence of "surprise" medical bills. This issue has been one of the Society's top state advocacy priorities since 2016, which has resulted in over 100 letters throughout 24 states. With the issue's rising prominence at the state level, it is no surprise that it has now escalated in Congress.

The draft – the Protecting Patients from Surprise Medical Bills Act – seeks to ban balance billing for both emergency and non-emergency services in select situations. The proposal would limit reimbursement for those scenarios to the greater of the median in-network amount or 125 percent of the average allowed amount.

Sen. Cassidy's office asked for input from the house of medicine and other interested stakeholders prior to formally introducing the bill. ASPS responded to the draft proposal with a number of substantial amendments that are necessary to protect providers and patients. Win a letter drafted by ASPS and cosigned by the American Association of Orthopaedic Surgeons (AAOS), the societies asked that balance billing remain a viable option for physicians and for the utilization of a minimum benefit standard to ensure fair payment for physicians. ASPS and AAOS also pushed for stricter network adequacy standards to be enacted to counter the narrow networks that have become commonplace since the passage of the Affordable Care Act (ACA).

While this is only the beginning of the federal effort to address out-of-network billing, ASPS expects this to become a much more prevalent issue during the 116th Congress.