Proven Solutions Needed for Out-of-Network Care

Jan 24, 2020 at 11:54 am by pj




The Physicians Society of Central Florida (PSCF) has been actively engaged in the ongoing debate in Congress over how to address out-of-network care and protect patients from the financial implications of receiving treatment from a physician that is not in their insurance carrier’s network.   Our concern is that any insurance company driven solution may negatively impact patients on a much larger scale. 


There is consensus in Washington, D.C., that we need to protect patients from the impact of receiving a surprise medical bill from a physician they believed to be in their insurance carrier’s network.   The PSCF supports that position.  The difficult choice before Congress is how to accomplish that goal without jeopardizing access to care and further deterioration of networks and local marketplaces.

There are proven models in states like New York and Texas that have provided a mechanism for insurers and health care providers to mitigate disputes without providing perverse incentives for insurance carriers to further narrow their networks.  


If the insurance industry is allowed to pay out-of-network physicians their average in-network contracted rate, they will be incentivized to further manipulate local markets by narrowing their networks and dropping higher quality physicians that may currently have the ability to negotiate higher reimbursement.   Such actions would result in decreased quality, reduced access to care, higher out-of-pocket costs, and more out-of-network billing for routine care, which is the total opposite of the stated goals of this initiative. 


We seek a solution similar to the State of New York which has seen a 30 percent reduction in out-of-network billing as they utilize charge-based benchmarks which encourage insurers to come to the table and negotiate reasonable contracts and expand networks. 


Congress should pursue proven solutions that will protect patients and not result in a one-sided victory for insurance companies. 


For more information please contact the PSCF at 844-234-7800 - Ext 5000.


Fraser Cobbe is the Executive Director of the Physicians Society of Central Florida