STATE | The New York State Society of Plastic Surgeons Strongly Supports ASPS's Statement on Out-of-Network Billing
The ASPS Executive Committee approved a position on out-of-network or surprise billing during the summer of 2016, and ASPS is preparing for nation-wide engagement during the upcoming 2017 state legislative sessions. The New York State Society of Plastic Surgeons (NYSSPS) has indicated its strong support of the main pillars of ASPS’s position, namely that patient education is a key component to addressing the issue of surprise billing and that a truly independent third party claims data repository – like FAIR Health, Inc. – should be used to set reimbursement levels in out-of-network billing situations.
Out-of-network or “surprise” billing has become a larger issue since the passage of the Affordable Care Act, because insurers have created cheaper, narrower, more complex, and in some cases non-transparent networks. The coverage of these narrow networks is not well understood by patients, and in most cases patients do not understand that they can receive care from a provider that is out-of-network at an in-network facility. ASPS’s position is that insurers, health care facilities and providers all play a role in educating patients about out-of-network billing, and NYSSPS supports this position.
NYSSPS also supports ASPS’s position that a truly independent patient claims database (like FAIR Health, Inc.) needs to be utilized to set out-of-network billing fee schedules. FAIR Health was created as the outcome of a lawsuit where insurers were manipulating claims data (Ingenix). Legislative alternatives include using a percentage of Medicare as a benchmark for setting reimbursement; however, Medicare rates are notoriously low. Insurers are also trying to advocate for the use of a usual and customary rate or a usual contracted rate for in-network providers (as determined by the insurer). ASPS will strenuously advocate that letting one party unilaterally set reimbursements in a non-transparent process is fundamentally flawed.
As New York has out-of-network billing legislation in place, NYSSPS has indicated that it will continue to share knowledge and expertise regarding this issue and will continue to support ASPS’s out-of-network billing advocacy efforts.