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News from the American College of Surgeons

For Immediate Release

CONTACT:

Christian Shalgian
202-672-1504
Email: cshalgian@facs.org

American College of Surgeons Opposes Alexander, Pallone, Walden Surprise Billing Plan

Proposed legislation imposes federal payment rate-setting on physicians and doesn’t allow physicians true access to a third-party review of health plan’s arbitrary rate-setting behavior

WASHINGTON, DC (December 9, 2019): The American College of Surgeons (ACS) opposes the plan related to surprise billing that was unveiled today by Senator Lamar Alexander (R-TN), and Representative Frank Pallone (D-NJ) and Representative Greg Walden (R-OR). While we agree that patients in emergency situations should not be responsible for anything more than the patient’s in-network share of the payment, the proposal today fails on two accounts when looking at the financial responsibilities of the health plan and the physicians:

  • When there is disagreement on the payment amount from the health plan to the out-of-network physician, the initial plan payment to the physician cannot be the mean or median in-network rate. Allowing the health plans to utilize insurer-dictated federal payment rate setting gives the health plans unfettered power of both out-of-network physician and in-network physicians. To this end, health plans would have significantly greater ability to lower the payments to in-network physicians who are paid above the median in-network.
  • When there is a disagreement between the health plan and the physician there should be access to an independent dispute resolution (IDR). Unfortunately, the plan released today states that the physician can only use the IDR if the allowable amount exceeds $750 for the service. A significant number of physician-provided services have less than a $750 allowable amount. For all those services, the physician would be forced to accept initial payment (median in-network contracted rate).

To make matters worse, Congressional leaders are attempting to enact bad policy in order to pay for other health care programs.

"All agree that disputes over payment should be resolved independent of patient involvement. However, this current proposal places far too much power in the hands of insurers and unfairly disadvantages physicians," said David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons.

Updated December 12, 2019

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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.