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Out of Network Billing


Protect Your Profession and Patients 

Surprise, or out-of-network, billing is the most important issue facing emergency physicians today. The decisions being made in Washington, DC could have widespread ramifications throughout the health care system, including cuts to physician reimbursement and reduced access for patients who need emergency care. 

The viability of the profession and America’s emergency care safety net is at risk.

For nearly a year, ACEP has been doing everything we can to advocate on behalf of emergency physicians and our patients on this rapidly-changing situation.

We are at a pivotal moment in our legislative efforts, and our grassroots advocacy is having an impact. Your livelihood as a physician is at risk both in terms of sharp reductions in salaries and reimbursement and restricted opportunities for where you can practice. These decisions could also reduce access to quality care for your patients. There is still time though to raise your voice and influence the outcome.

The following toolkit provides messaging guidance and other resources such as a template op-ed and social media posts to help promote ACEP’s advocacy position.

Please click on each individual image to download the independent dispute resolution infographic, fact sheet or the ACEP Member Surprise Billing Advocacy Toolkit.

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 physicians 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. This is especially true in the hospital-based setting in general and in emergency medicine in particular. Insurance companies are seeking state legislative solutions to deny out-of-network physicians any recourse other than to accept payments unilaterally and arbitrarily chosen by the insurers as payment in full.

The resources on this page are designed to assist members dealing with state and federal legislative efforts to restrict the ability of out-of-network emergency physicians to receive fair payment for the care provided to patients.

Want to get involved? Group leaders are encouraged to sign a pledge form that their physician group is committed to these best practices in contracting to ensure the best interests of our patients. The demonstrated commitment and amount of emergency visits encountered will help show lawmakers that the payers are the problem - not us! 

Learn more about ACEP's advocacy work on this issue

Recent Op-Ed: Patients Should Count More Than Profits
https://floridapolitics.com/archives/310579-sean-shaw-dont-let-insurers-put-profits-over-patients

 

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