Statement attributable to AOA President Thomas L. Ely, DO, and AOA CEO Kevin M. Klauer, DO, EJD:
The American Osteopathic Association (AOA) appreciates House and Senate leaders’ and committees’ efforts in developing legislation that protects patients from surprise medical bills, while also establishing requirements intended to promote equitable resolution of charges for out-of-network services.
Congress has been working to address surprise medical bills over the past two years. While the AOA has always shared the goal of protecting patients from surprise medical bills and removing patients from any payment disputes between insurers and physicians, we have continually called on Congress to take steps to address the root causes of out-of-network charges. The AOA has regularly urged Congress to strengthen network adequacy requirements and incentivize payers and providers to negotiate equitable resolutions to payment disputes in good faith. The No Surprises Act protects patients from surprise medical bills and takes important steps toward promoting good faith negotiations between payers and providers.
Early versions of the legislation did not include any form of arbitration. When one was included, it required a high-cost threshold for charges to be eligible, with no batching, and would have likely excluded many medical services that would otherwise be eligible. The version of the legislation being finalized this week includes an independent dispute resolution (IDR) process that does not have a minimum threshold and allows for batching of claims. The IDR process can also include the median in-network rate in the geographic area, as well as a physician’s training and experience, market share, prior contracted rates, and complexity of case when determining payment. The AOA is particularly grateful to Congress for addressing recent feedback from the AOA and other healthcare organizations in the No Surprises Act, such as increasing the time that a physician would have to request IDR from two days to four days. Additionally, the bill will require a report to Congress one year after implementation to ensure that the IDR process is functioning as intended.
As Congress moves forward with votes on end-of-year legislation, the AOA expresses its appreciation for efforts to develop policies that protect patients and support our country’s physicians at this critical time.
Read a complete summary of Congress’ 2020 year-end package, which addressed many issues the AOA advocated on this year.