Patients and Physicians Rally to End the Surprise Insurance Gap

ATLANTA–(BUSINESS WIRE)–In a Capitol Rotunda rally, a coalition of physicians and patientadvocates today endorsed a platform of key guidelines they say should beincluded in legislation intended to end balance billing in the emergencydepartment.

The Medical Association of Georgia (MAG), the Georgia College ofEmergency Physicians (GCEP), and the Epilepsy Foundation of Georgia arejoining forces in a campaign to support legislative efforts that protectpatients from unexpected gaps in insurance coverage that can lead tosurprise medical bills in emergency care — care insurance companiesrefuse to cover. More organizations are expected to join the campaign inthe coming days.

The campaign includes a videodesigned to highlight the problem, statewide advertising, a robustsocial media movement, and an advocacy blitz by the organizations tourge their members to contact their representatives to voice support forthe following guidelines to end the surprise insurance gap:

The patient should be held financially harmless for unexpectedOut-Of-Network (OON) care.

Any patient deductibles and cost-sharing for unexpected OON careshould be applied to in-network rates.

An appropriate and fair standard should be created for out-of-networkservices that establishes a charge-based reimbursement schedule(meaning 80th percentile) connected to an independently recognized andverified database.

Physicians would no longer submit balance bills to patients forservices rendered.

Greater transparency should be required of insurers. Specifically,

network provider directories should be easily accessible for bothpatients and physicians, updated immediately and completelyaccurate, and

patients should have access to information on the average charge,reimbursement rate, and expected out-of-pocket costs for anyhealth care service or procedure in all geozips.

Insurance carriers should be prevented from providing false,misleading and/or confusing information in regards to coverage.

“Insurers are narrowing their physician networks to shift costs onto thebacks of patients and physicians,” said Steve M. Walsh, MD, President,Medical Association of Georgia. “In the event of an emergency, healthinsurance companies shifting costs is more insidious. Knowing thathospitals are required by federal law to provide emergency care for allpatients, regardless of their ability to pay, insurers are forcingphysicians out-of-network – even at hospitals within their networks. Theresult is a surprise insurance gap that is creating financial hardshipfor too many patients and eroding the doctor-patient relationship.”

The Epilepsy Foundation of Georgia said the organization is supportingthe guidelines because they hold patients harmless for medical costsinsurers should cover. Each organization indicated ending the surpriseinsurance gap was a top priority for this legislative session.

“What good is insurance coverage if it abandons you in an emergency?”asked Aly Clift, Executive Director, Epilepsy Foundation of Georgia.“Insurance companies need to hold up their end of the bargain and bethere when patients need care most.”

The coalition said the insurance company lobby has pushed for a ban onbalance billing, but their proposals would do nothing to solve theproblem. In fact, a ban on balance billing with no transparency, noimprovement on patient protections, and no mechanism for fairreimbursement for physicians would put up barriers for patients toaccess emergency care, especially in rural Georgia. It would end upleaving physicians with reimbursements far below the cost of providinglife-saving services.

“Our patients need surprise insurance gap protections and physiciansneed to be adequately paid for their services,” said Matt Keadey, MD,President-Elect, Georgia College of Emergency Physicians. “Theguidelines we think need to be in any legislation addressing surprisebilling do just that by removing patients from any physician-insurerpayment disputes and requiring a floor for out-of-network reimbursementsat in-network facilities. These guidelines are a step in the rightdirection to fix a problem that has impacted too many Georgians.”

The groups represented here believe that an appropriate and fairreimbursement standard for out-of-network services should be determinedusing a database of medical service prices (or charges) in a geographicarea that is maintained by an independent non-profit organization notaffiliated or financially supported by an insurance carrier.

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