AAOS critical of bipartisan surprise billing legislation


Democrats and Republicans in Congress have come together to propose new surprise billing legislation: the Lower Health Care Costs Act of 2019.

The new legislation would create a dispute resolution system to replace balance billing with arbitration. The bill includes the Independent Dispute Resolution and a lowered threshold for accessing the process, which American Academy of Orthopaedic Surgeons President Kristy Weber, MD, supports in a statement.

However, she was critical of the bill's use of median in-network rates because they are controlled by insurers.

"Even when filtered through arbitration, the use of this rate as a benchmark is tantamount to government rate-setting," she stated. "It will allow insurers to systematically drive down in-network rates to serve their bottom line, consequently harming patient access to care throughout the country. Furthermore, the new 90-day waiting period between disputes for the same procedure undermines the effectiveness of the IDR process which sole purpose is to bring both sides to the table and incentivize fair, reasonable offers."

AAOS urged Congress to incorporate the fair market IDR standard, which is currently used in New York.

The American Hospital Association was also critical of the bill for similar reasons.

"An arbitrary rate gives insurers an incentive to remove hospitals from their networks and force artificially low reimbursement rates, which limits access. Moreover, such proposals would provide a huge windfall to commercial insurance companies at the expense of the nation's community hospitals," the AHA said.

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