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AAMC, Medical Groups Send Letter to Congress on Surprise Medical Bills

October 18, 2019

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PRESS CONTACTS
Allyson Perleoni, Senior Legislative Analyst

The AAMC, along with other national medical associations including the American Medical Association (AMA), sent a letter Oct. 16 to both House and Senate leadership outlining concerns about the current legislative approaches for addressing surprise medical bills. The letter also proposes solutions to protect patients from surprise medical bills without destabilizing the health care system.

Congress has weighed several proposals to address surprise medical bills, including benchmark rate setting and the use of an independent dispute resolution (IDR) process. Provider groups have raised concerns about a benchmark rate, particularly in that it would set a payment “ceiling” that insurers could use to underpay providers. The effects of this payment ceiling, the letter argues, would cause an imbalance that “will likely lead to access problems for patients seeking hospital-based care from on-call specialists, as well as precipitate staffing shortages in rural areas and other underserved communities.”

The letter urges Congress to reject a benchmark rate and instead to look at the success of IDR in states that have implemented it. The letter suggests that the process “be structured so that a range of factors is considered in determining a mutually fair payment—such as the complexity of the service rendered, the experience of the physician providing the service, the rate that physicians or other providers charge for the service in a geographic area, and commercial insurance data from an independent and transparent source.”

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