Talking Points Supporting the Right to Balance Bill
Talking Points Supporting the Right to Balance Bill
Retaining the right to balance bill patients protects the fundamental right of physicians to set their own fees and to decide whether or not they want to participate in a managed care network. Without this ability, compensation for non-contracting physicians would be set either by the state (through a state-mandated formula) or, in the absence of specific state instructions, by the managed care companies themselves. Whether fees are restricted by the state or by the managed care companies, physician compensation will suffer. In an environment where emergency care providers already provide inordinate amounts of uncompensated and undercompensated care, further erosion of physician compensation could greatly exacerbate the problems associated with attracting and retaining emergency physicians.
While the bill purports to help patients, it would ultimately hurt them by reducing their access to quality emergency care, as fewer physicians would be able or willing to practice.
Prohibiting balance billing is not a patient protection initiative; it is a profit protection initiative for managed care companies. This would replace a free and open market, based on competitive pricing, to protect already profitable HMOs.
Removing the right to balance bill patients also removes a key incentive for managed care companies to negotiate with physicians in a good faith effort to convince physicians to join a managed care network. Without balance billing capabilities, negotiating power would be stripped from physicians.
Due to EMTALA, emergency care providers are uniquely and severely punished by a ban on balance billing. Emergency physicians cannot choose to see or not see patients because of their insurance status.
The overcrowding problem at Emergency Departments could easily worsen as the ED becomes the de facto in-network option for everyone.
Prohibitions of balance billing raises potential legal concerns, especially in those cases where non-contracting providers are required to accept whatever rates the managed care company chooses to pay. Such actions could violate due process provisions by requiring providers to accept compensation that a third party unilaterally sets. Additionally, giving insurers the right to unilaterally set provider fees may be an inappropriate delegation of the state’s ratemaking power. (However, providers should not have an expectation that a legal challenge would be successful. There is no known precedent for success in challenging balance billing laws.)
