Lawmakers

Fact

62 percent of ER doctors say most health insurance plans provide less than adequate coverage for emergency care visits.

How this impacts your constituents

Surprise medical bills are the symptom of a larger problem – a surprise insurance gap. This coverage gap leads to surprise bills. Increasingly narrow and tiered insurance networks can leave patients without options. High deductibles and outdated provider directories exacerbate the problem, leaving patients confused and misled. The result is that patients, through no fault of their own, are being caught in the middle. We need to end this insurance gap through comprehensive legislation that improves protections for patients, ensures fair and reasonable reimbursement for physician services, and ultimately preserves access to care.

The Solution: End the surprise Insurance Gap

A comprehensive and fair solution needs to address the underlying issues that cause surprise bills.  Our legislative guidelines ensure strong patient protections, improve transparency, and establish a fair reimbursement standard.

 

  • Patients should not be financially penalized for unexpected out-of-network (OON) care.

     

  • In-network rates should be applied to any patient deductibles and cost-sharing.

     

  • An appropriate and fair standard should be created for out-of-network services using a reimbursement schedule connected to an independently recognized and verified charge-based database.

     

  • Physicians should no longer submit balance bills to patients for unexpected out-of-network care.

     

  • Insurers should be prevented from providing misleading and confusing information regarding coverage.

     

  • Strong penalties for insurance companies and physicians that violate this law should be established so patients are always protected.

     

  • Greater transparency should be required of insurers. Specifically, network provider directories should be easily accessible for both patients and physicians, updated immediately and completely accurate.

Physicians for Fair Coverage developed The Patient Protections and Transparency Act of 2018, model legislation designed to create a fair, comprehensive solution that will end surprise bills for unexpected, out-of-network care, and provide protections for patients from the financial impact that narrower networks and cost-shifting trends within health insurance can create.  State legislatures across the country are using these guidelines to bring and end to surprise insurance gaps.

 

You can download a section-by-section summary of The Patient Protections and Transparency Act of 2018 here.

You can download the bill language for The Patient Protections and Transparency Act of 2018 here.

 

We would like to talk to you about our efforts and active legislation in your state.  Please contact us at info@endthesurpriseinsurancegap.org or call us at 1-703-610-9035 for more information about how to get involved in ongoing policy efforts in your area.

 

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