American Society of Plastic Surgeons
For Consumers

Ohio: Flawed Out-of-Network Bill Vetoed

The Ohio out-of-network conversation began back in summer 2018 when ASPS hosted a call with the Ohio State Medical Association (OSMA), emergency medicine and radiology regarding efforts to advance out-of-network legislation in the state. That outreach led to a second call to coordinate potential efforts with other national stakeholder groups to determine next steps. Following those initial discussions, providers began strategizing for 2019 legislation and regrouped in December 2018 to put together an agreed-upon plan. Those calls turned into further strategy sessions in January and February.

Fast forward to May and the state legislature was deadlocked in budget negotiations, which included dueling out-of-network proposals in the Ohio House of Representatives and Ohio Senate. The House version included language that would have tied out-of-network reimbursement for emergency services at the greater of a health plan's in-network rate or its out-of-network rate. Moreover, the House version would have pegged reimbursement for nonemergency services to either the in-network rate or a plan's out-of-network rate.

As the state budget bill advanced, OSMA met with legislative leaders to attempt to amend the measure to something that would be more favorable for patients and physicians. During that time, ASPS connected with OSMA staff to provide materials and reports highlighting the efficacy of other state-level models (i.e., the New York model) to aid in their ongoing lobbying efforts. As a result of that advocacy by OSMA, members of the state Senate removed the unfavorable language and replaced it with provisions that would reimburse physicians at fair market value for unanticipated out-of-network care and created an arbitration process to allow physicians to challenge unfair reimbursement.

Due to the opposing approaches to solving unanticipated out-of-network billing and many other issues, a conference committee was convened to hammer out a final bill to send to Gov. Mike DeWine. ASPS joined other stakeholder groups in urging the conference committee to adopt the Senate out-of-network provisions. Unfortunately, the committee ultimately accepted the House version of the bill.

During an extended session, OSMA and other on-the-ground stakeholders urged Gov. DeWine to line-item veto the out-of-network provision. We are pleased to report that, at the request of the medical community, Gov. DeWine opposed the insurance industry's preferred approach and vetoed the House language.