Out of Network Billing

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 chapters dealing with legislative efforts to restrict the ability of out-of-network emergency physicians to receive fair payment for the care provided to patients.

 

Video

Panel discusses national and local impact. From the 2017 Leadership & Advocacy Conference.

Background

AMA primer on the balance billing issue and the policies than can best protect patients.

Fact Sheets

Presentations and studies as well as quick talking points about the national and local impact.

Strategies and Proposed Solutions

ACEP-EDPMA Joint Task Force strategies, & consensus papers from ACEP, ASA, ASPS and ACR

Model Legislation

Includes documents of guiding principles, explanatory notes and strategic guidance.

Testimony and Letters

See what ACEP is saying about proposed national & state legislation, and alternative solutions.
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