On Friday, March 22, the Brookings Institute held an event to present its analysis on potential state-level policies to eliminate surprise out-of-network billing.
Introductions and Analysis Presentation
Lead author Dr. Loren Adler details two possible approaches:
- Billing Regulation “Which relies on capping or setting what out-of-network providers can charge patients and health plans in surprise situations, either by explicitly choosing a rate or determining it through an arbitration process. Additionally, fully-insured health plans would be required to treat such services as in-network for purposes of enrollee costsharing.”
- Contracting Regulation Which would require all “ED and ancillary clinicians, hospitalists, and neonatologists to contract with the same health plans as the facility or facilities they practice in, or through a prohibition on these physicians contracting with health plans or billing patients directly.”
Full Report: State Approaches to Mitigating Surprise Out-of-Network Billing Adler Presentation Slides: Policy Approaches to Addressing Surprise Out-of-Network Billing
Panel Discussion: Policymaker
The Policymaker panel discussion was moderated by Mark Hall, Nonresident Senior Fellow of Economic Studies, Center for Health Policy. Panelists included:
- Jessica Altman, Commissioner Pennsylvania Insurance Dept.
- Jane Bayer, Washington State Office of Insurance Commissioner
- Lauren Block, Program Director-Health Division, National Governors Association
- Marry Moody, Health Policy Advisor, Office of Senator Bill Cassidy
Panel Discussion: Stakeholders
Paul B. Ginsburg, Director of the USC-Brookings Schaeffer Initiative for Health Policy, moderated the stakeholder panel discussion. Panelists included:
- Claire McAndrew, Director of Campaigns and Partnerships, Families USA
- L. Anthony Cirillo, Board Member, American College of Emergency Physicians
- Molly Smith, VP of Coverage and State Issues Forum, American Hospital Association
- Jeanette Thornton, Senior VP of Product, Employer, and Commercial Policy, America’s Health Insurance Plans