Surprise Billing Alert: General Assembly deals devastating blow to EM safety net
Harmful provisions would keep payment decisions in the hands of insurers
On Tuesday, July 17, the legislative conference committee on House Bill 166, the state budget bill for Ohio, dealt Ohio’s physicians a devastating blow with the passage of language harmful to physicians on the issue surprise/out-of-network billing.
The language adopted by the conference committee will require payment at the greater of:
- The in-network rate, which is vaguely defined and still leaves the calculation up to insurers;
- The out-of-network rate; or
- The Medicare rate.
This means all reimbursement decisions are ultimately in the hands of the insurers.
The language does add an alternative dispute resolution (ADR) process, but not for claims under $700. And the ADR process is only allowed if the provider doesn’t believe the insurer is reimbursing the correct rate under the greater of 3 above.
It is clear the Ohio’s emergency medicine safety net cannot be sustained under these conditions.
Ohio ACEP’s leadership and Government Affairs team has crafted a letter to Governor Mike DeWine requesting a veto of these items. The letter highlights the specific flaws in the proposal slipped into the budget at the last minute and asks the Governor to veto the provisions to allow for a more thorough and transparent discussion about this topic.
Developments are happening quickly, and Gov. DeWine is expected to make decisions soon on which portions of the budget bill he will veto. Stay tuned for updates.
In the meantime, thanks to all of you who answered our call to reach out to your state representatives and senators to ask that they reject the harmful surprise billing language of the House’s bill and to support the language drafted in concert with the Senate leadership, based on the New York model, which would have truly protected patients and the physician community.