American Association of Orthopaedic Surgeons (AAOS) President Kristy L. Weber, MD, FAAOS, issued the following statement in response to a new combined version of the Lower Health Care Costs Act of 2019 addressing surprise medical bills:
“The AAOS thanks Congress for its dedication to finding a solution that removes patients from the middle of medical billing disputes. We appreciate that the new version of the bill includes Independent Dispute Resolution (IDR) as well as a lowered threshold for access to this critical process. These positive improvements, however, are overshadowed by the committees’ continued use of the median in-network rate—a number controlled by insurers.
“Even when filtered through arbitration, the use of this rate as a benchmark is tantamount to government rate-setting. It will allow insurers to systematically drive down in-network rates to serve their bottom line, consequently harming patient access to care throughout the country. Furthermore, the new 90-day waiting period between disputes for the same procedure type undermines the effectiveness of the IDR process which sole purpose is to bring both sides to the table and incentivize fair, reasonable offers.
“As Congress evaluates this proposal and considers passing legislation before the end of the year, AAOS urges it to incorporate proven solutions like the fair market IDR standard employed successfully in New York. Using an independent database outside of physician or insurer control is the only way to protect access to care while saving consumers millions of dollars and taking patients out of the middle.”