Our organization, Grassroots Emergency Medicine wants to protect patients from Surprise Billing without disrupting America's Safety Net health care that is provided by Emergency Departments nationwide.

Surprise medical billing, also called balance billing or out-of-network billing, can occur for many reasons. Emergency medical services have been blamed for the majority of these Surprise Bills although they occur in non-emergent situations and have be associated with other medical specialties as well.

Emergency physicians want patients to be held harmless and understand that the reason these bills have become more prevalent are due to systematic efforts by health insurers to maximize their profit and minimize covered health services. Health insurers have contributed to this problem by increasingly narrowing their networks, refusing  to negotiate contracts with physicians, abusing the EMTALA mandate and retroactively denying coverage for Emergency Department visits and by expanding high deductible health insurance plans - cost shifting more of health care expenses to patients who already are paying record health insurance premiums.

​Congress has been working on legislation to end Surprise Billing but one of the proposed solutions, known as Benchmarking, will put Emergency Medical Care access and patients at risk, threatens to worsen physician shortages and lead to hospital closures.

We are writing to express Opposition to Surprise Billing Solutions, such as Benchmarking, that will place patients’ access to quality medical care at risk, especially those living in medically underserved and rural areas. 

Emergency Departments are on the front lines of America’s health care system and the front door to every hospital. Not only do they provide care for acute and critical emergencies but also serve as the primary method for admission to hospitals, and provide countless services to address public health crises, such as: disease outbreaks, treating the Opioid Use Disorder and Substance Abuse, addressing homelessness, lack of mental health care access, and health care to all who present including undocumented immigrants and those with no other access to health care. What will happen to the ability to provide these services as once Benchmarking passes?

Nationally, emergency physicians care for more than 145 million visits to the emergency department annually. Nearly two-thirds of those patients are covered by Medicaid, CHIP or Medicare, a little less than one-third are privately insured and the remaining patients (approximately 6%) are uninsured or self-pay (HCUP).  EMTALA mandates Emergency Physicians perform a medical evaluation and stabilize every patient that presents to the Emergency Department. Insurance companies know this and have used the EMTALA, unfunded mandate as another method to avoid providing insurance coverage for patients.

Benchmarking will provide insurance companies with a Federal invitation to exit contract negotiations, pushing more patients OON, increase healthcare consolidation and lead to higher health costs, increase hospital closures, and exacerbate the physician shortage leading to poorer quality and decreased access to medical care.

Congress must support an accessible Independent Dispute Resolution (IDR) process to protect patients’ access to quality emergency medical care, especially in rural and underserved areas of the country. The IDR must be set at a threshold (ie $200-250) that is accessible for hospitals and Emergency Physicians; should have a fair third-party arbiter; and reference a non-insurance owned and operated claims database, such as FAIR Health.

Failing to address the root cause of Surprise Medical Bills and instead provide insurers with a federal incentive to exit contracts with hospitals and physicians, places insurance companies at an unprecedented advantage over physicians without any corresponding accountability.

We support a solution Balanced Billing that includes an arbitration process, which has been adopted and demonstrated in the state of New York and proven to be a fair solution for all: patients, providers and insurers. This style solution has been proposed by Reps. Ruiz (D-CA) and Roe (R-TN) in the overwhelmingly popular, H.R. 3502 which has over 105 co-sponsors. Why would other proposed solutions with only two-three cosponsors be considered as the framework to solve Surprise Billing? Similar solutions proposed by Sen. Cassidy (R-LA) and the Bipartisan Price Transparency Working Group also recommended utilizing an arbitration process.

IDR provides the best method to protect patients from billing disputes and establishes a fair, proven, and efficient process to resolve differences between insurers and providers. IDR will not increase administrative costs, as falsely reported by the CBO, as the losing party in the arbitration covers the administrative costs, not the patients or the government. Finally, IDR incentivizes fair offers for reimbursement from insurers and fair charges from hospitals and physician staffing. Gov. Cuomo announced earlier this year that New York state saved patients over $400 Million in only three years.[1]

The framework offered by Reps. Ruiz and Roe in H.R. 3502 should serve as the foundation for Congress’ ongoing efforts to protect patients from Surprise Medical Bills.