American Society of Plastic Surgeons
For Consumers

STATE | ASPS Faces Out-of-Network Battles Across the Country

Over the past four months, ASPS joined coalition efforts to address out-of-network (OON) legislation in Idaho, Georgia, Oregon, and Washington. In each of those states, measures attempting to set unfair reimbursement rates for OON services were introduced and advanced through part, or all, of the legislative process.

Thanks to the efforts of a coalition led by the Idaho Medical Association, out-of-network legislation failed to advance in 2018. The measure would have banned balance billing for emergency services and required providers to accept the greater of 85 percent of the in-network rate or 145 percent of Medicare for OON emergency care. This legislation was successfully defeated before it advanced in the state legislature. ASPS supported the coalition efforts and coordinated a letter signed by ASPS members in Idaho expressing strong opposition to the measure.

In Washington state, a 2017 measure was carried over into the 2018 legislative session. This bill would ban balance billing and require reimbursement to be set to the greater of the median in-network rate, median OON allowable rate, or 175 of Medicare. The Washington State Medical Association led a broad coalition that included numerous national specialty societies, as well as Physicians for Fair Coverage (PFC), that aimed to stop the bill from getting a vote on the state Senate floor. During that process, ASPS worked in conjunction with the Washington Society of Plastic Surgeons and the Northwest Society of Plastic Surgeons to craft comments in opposition to the measure. Subsequently, ASPS engaged in grassroots advocacy during the coalition's final push to stop the bill before it was called for a floor vote in the Senate. This concerted effort between WSMA, ASPS and specialty medicine paid dividends as the bill was killed before the end of the regular session.

Unfortunately, efforts to kill egregious OON legislation in neighboring Oregon did not prove as successful. Legislation that requires physicians to accept the median allowed amount paid to in-network providers by commercial insurers in Oregon passed the legislature and was signed into law by Governor Kate Brown. ASPS opposed this measure throughout the legislative process. The measure calls for an advisory group to deliberate and provide further input on OON reimbursement rates. However, codifying the median allowed amount paid by insurers is seen as detrimental to future efforts to set fair and adequate reimbursement rates.

ASPS and the Georgia Society of Plastic Surgeons (GSPS) supported legislation drafted by the Medical Association of Georgia (MAG) during the 2018 legislative session. Following numerous letters, grassroots advocacy and coalition efforts to advance the legislation, the MAG bill successfully made its way to the floor of both chambers. However, a rival measure was brought forward by opponents in the state House of Representatives. Ultimately, both bills failed to make it to the governor's desk. The Georgia legislature has since concluded its session and ASPS is working with MAG and other specialty medicine groups to advance MAG's legislation in 2019.