American Society of Plastic Surgeons
For Consumers

STATE | NV Gov. Sandoval Vetoes Out-of-Network Billing Legislation

Last month, the Nevada legislature passed a measure that would permit insurance companies to unilaterally determine reimbursement rates for physicians who provide out-of-network care. Under this bill, a physician who renders out-of-network care would be required to accept a "reasonable rate" offered by an insurance plan. If the physician determines this rate "unreasonable", a period of negotiation would follow and terminate in binding arbitration. The arbitrator would set the rate based on: 1) the average amount for in-network care; 2) the Medicare rate; and 3) the usual and customary rate for out-of-network care.

This legislation, which was intended to address surprise billing, threatened the stability of the state's health care delivery system, including Nevada's ability to recruit and retain physicians. If passed as written, insurance companies would have no incentive to contract with physicians as they would only be liable to pay providers the legislated "discount" payment. This is inherently unfair to patients and physicians. ASPS believes that insurers with narrow networks should instead face penalties and be required to pay fair and equitable reimbursement.

ASPS opposed this legislation throughout the legislative process and urged Governor Sandoval to veto this problematic bill. ASPS conducted grassroots advocacy and encouraged plastic surgeons in the state to contact the Governor and voice their concerns. The Society also worked in conjunction with other physician specialties, including the Physicians for Fair Coverage, to place additional pressure on the Governor's office. On June 8, Governor Sandoval heeded the warnings of physicians and patients by vetoing the bill. ASPS will work with the medical community in Nevada to draft thoughtful legislation to address surprise billing during the 2018 legislative session.