Senate’s ‘Surprise Billing’ Proposal Attacks Independent Physicians, Benefits Insurers


A bipartisan group of senators led by Bill Cassidy (R-La.) is proposing a bill that would impose price controls on independent (“out of network”) physicians, under the guise of preventing outrageous “surprise bills” and medical bankruptcies, states the Association of American Physicians and Surgeons (AAPS). It would relieve the insurance industry of its responsibility to pay adequately for life-saving care.

Proponents cite a few examples of shocking bills, such as a $17,000 urine test, that patients probably were never really expected to pay, states AAPS. Most outrageous bills come from hospitals, not from physicians who refuse the terms offered by network contracts.

Hospitals may have out-of-network physicians on their call schedules because not enough in-network physicians are willing to do the work. Unacceptable constraints on their professional judgment as well as a desire to have time to work in charity care lead many excellent physicians to refuse to sign insurance contracts, AAPS points out. Additionally, many managed-care plans have very narrow networks, and may have no doctors in the specialty that a patient needs, or none within a reasonable distance.

What the bill does, states AAPS, is to empower the managed-care cartel to impose caps on prices charged by any physician or hospital that treats one of their subscribers—even though the physician or hospital has no relationship with the payer.

This means that both patients and physicians are deprived of the right to receive and provide medical services on mutually agreeable terms, and are subjected to the diktats of third-party payers that are effectively accountable to no one. These payers could drive independent physicians and facilities out of the market and deprive their subscribers of access to life-saving services that are “covered” but not available in network.

Sen. Cassidy claims he wants to protect patients against bills that are “uncapped by anything but a sense of shame.” In a free market, prices are driven down by competition, AAPS states. “We need a free market with honest price signals, instead of one where managed care and hospitals collude to keep prices and insurance reimbursements secret—and very high. Balance billing is not a problem ‘ripe for a federal solution.’ In fact, it is essential for ensuring availability of needed services for which third parties refuse to pay.”

The Cassidy proposal resembles a California law that AAPS is challenging in AAPS v. Rouillard as an unconstitutional taking from physicians who elect not to contract with third parties and as harmful to patients, especially low-income patients, who are losing access to care.

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943.