End Surprise Medical Billing, AAFP Tells Lawmakers

Patient-physician Relationship Hurt by Harmful Practice, Academy Warns

October 17, 2019 02:07 pm News Staff

Congress' failure to pass restrictions on surprise medical billing would be "unacceptable," the Academy cautioned lawmakers earlier this month, as multiple draft laws affecting family physicians and their patients remained in committee.

[elderly couple reviewing medical bill]

"This is a problem that requires a federal solution," the AAFP said in an Oct. 10 letter(2 page PDF). The correspondence was sent to Reps. Richard Neal (D-Mass.) and Kevin Brady (R-Texas) -- the chair and ranking member, respectively, of the House Ways and Means Committee -- and signed by Board Chair John Cullen, M.D., of Valdez, Alaska.

Unexpected bills -- generated when out-of-network physicians and other clinicians care for patients who have sought treatment at in-network facilities or experienced an emergency -- have increasingly yoked Americans to substantial, if not crippling, medical costs(jamanetwork.com) and chilled the patient-physician relationship.

Along with pharmaceutical pricing and transparency, surprise billing has dominated health care discussions in Congress this year and been the subject of multiple hearings. In response to the Lower Health Care Costs Act(www.congress.gov) -- and in reference to other draft legislation introduced this session -- the Academy said increased investment in primary care and protection from surprise bills(5 page PDF) are key to ensuring patients can access and afford health care.

In February, the Academy joined more than 100 state and national medical organizations in a similar letter to the committee.

"Strong oversight and enforcement of network adequacy is needed from both federal and state governments," said that correspondence, which further advised that patients should be billed only at in-network cost-sharing rates.

The Academy's most recent letter reiterated these points and added: "This problem is worsening, and patients literally cannot afford for Congress to do nothing."

Congress must also avoid increasing premiums, however.

Legislation addressing surprise billing, the AAFP noted, must consider not only the immediate impact of such bills on patients' out-of-pocket costs but also "the overall impact on insurance premiums paid by patients, employers and the government."

"It would be counterproductive to create a policy designed to protect patients from excessive costs that ultimately results in increased coverage costs and decreased value for patients," the letter said.

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