In recent years a growing number of states have considered legislation that would regulate out of network reimbursement and balance billing. The issue has grown in importance as insurance companies have narrowed their networks, in the process reducing the contractual rates they are offering to participating in their networks. At the same time, insurance consumers have been facing heavier financial responsibility in the form of higher co-payments and deductibles imposed under their insurance plans, leaving them often surprised at higher than expected bills for which they erroneously attribute responsibility to their health care provider.

The resources on this page are designed to assist chapters dealing with legislative efforts to restrict the ability of physicians to receive adequate payment for the care provided to patients.

This Strategies to Address Balance Billing document represents the effort of the ACEP/EDPMA Joint Task Force in collaboration with ACEP’s Reimbursement Committee and State Legislative/Regulatory Committee. It includes a helpful glossary section as well as sample legislative approaches and a summary of state laws and current activity. Download PDF.

These slides were presented by ACEP President Jay Kaplan at the State Legislative Strategy Conference in January 2016. Download PDF.