Purpose: In July 2019, the House Energy and Commerce Committee reported out H.R. 3630, the No Surprises Act. This legislation is intended to safeguard patients from exorbitant medical bills when services are received from out-of-network physicians and facilities. We evaluate the current bill, proposed amendments to the bill, and the implications of the policy changes for interventional radiologists.
Materials and Methods: The H.R. 3630, the No Surprises Act, legislation was reviewed. Additionally, current literature was reviewed to identify articles related to out-of-network medical billing.
Results: The policy intends to prohibit out of network physicians and facilities from billing patients for more than a benchmark rate set at the median in-network payment in the geographical area where the care was received. This may result in physicians and hospitals being forced to accept unreasonable rates set by the insurance companies. The out-of-network groups may lose negotiating power because insurance companies would not have an incentive to contract with physician groups, knowing that reimbursement is set at a benchmark rate. The benchmark rate could also be manipulated if insurance companies decide not to renew contracts with rates above the median for a given geographical area. This could force providers to accept undervalued rates without ever having negotiated with an insurance provider. Additionally, the lack of incentive to negotiate contracts would lead to narrower insurance coverage networks. To mitigate the increasing influence of insurance companies and maintain the negotiating power of healthcare providers, a House bill amendment has been introduced. The amendment supports a neutral, independent dispute resolution (IDR) process when claims exceed $1250. Similar legislation was recently passed in Texas, SB 1264, which has an IDR process that removes the patient for the dispute resolution process. Given the integral role of interventional radiologists in acute patient care, this policy may have a potentially harmful effect on IR practices.
Conclusions: Surprise billing legislation could have wide-sweeping implications on the practice of medicine by hindering physicians abilities to freely contract with payors, decreasing reimbursement, and narrowing health insurance networks. Political advocacy efforts are critical to maintaining the value of interventional radiology services and patients access to minimally invasive procedures.