HospitalsRegulatory

Blue Cross Blue Shield Association calls for federal ban on balance billing

Kelly Gooch – Monday, June 3rd, 2019

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.

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Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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