The Blue Cross Blue Shield Association wants Congress to establish a payment benchmark for out-of-network clinicians, such as emergency room physicians, as part of a legislative solution to surprise medical bills, according to Bloomberg Law.
The major health insurance group's website says it wants to protect patients from unexpected bills from out-of-network physicians after receiving care at in-network facilities, particularly in situations where they cannot control who provides the care.
To accomplish this, the association recommended that federal lawmakers ban the practice of balance billing, when a patient is on the hook for additional charges after the insurance company has paid the medical practitioner.
The association — which represents 36 U.S. Blue Cross Blue Shield companies — said federal surprise-billing legislation should also include a "clearly defined" benchmark regarding payments for out-of-network practitioners associated with surprise medical bills. The group recommended that payments for out-of-network physicians at in-network hospitals be based on Medicare rates or the plan's contracted rate for in-network physicians in the area, whichever is higher.
"The government would develop this methodology so it is made standard. This approach would build on the existing system of negotiations between health insurers and medical professionals, with the goals of minimal disruption, fairness, transparency and predictable payment amounts," the association added.
Republicans and Democrats have come forward with various proposals to address surprise billing.
Physicians, hospitals, insurers and legislators generally agree: No one wants patients stuck with an outrageous "surprise bill," but , they don't agree on how to solve the problem.
One point of contention is how to handle billing disputes, according to Bloomberg Law.
While insurers have supported rate-setting policies, hospitals want Congress to consider dispute resolution methods, such as mediation and arbitration.
Justine Handelman, senior vice president in Blue Cross Blue Shield Association's Washington office, told Bloomberg Law and other media in a press briefing that arbitration to resolve disputes between medical providers and insurers could “open the door to higher costs down the road" for consumers and health systems.
Read more about the association's recommendations here.