Brookings Institute Analysis: Surprise Out-of-Network Billing

Brookings Institute Analysis: Surprise Out-of-Network Billing

Brookings Institute Analysis and Panel Discussions on Surprise Out-of-Network Billing

On Friday, March 22, the Brookings Institute held an event to present its analysis on potential state-level policies to eliminate surprise out-of-network billing.

Introductions and Analysis Presentation

Lead author Dr. Loren Adler details two possible approaches:

  1. Billing Regulation
    “Which relies on capping or setting what out-of-network providers can charge patients and health plans in surprise situations, either by explicitly choosing a rate or determining it through an arbitration process.

    Additionally, fully-insured health plans would be required to treat such services as in-network for purposes of enrollee costsharing.”

  2. Contracting Regulation
    Which would require all “ED and ancillary clinicians, hospitalists, and neonatologists to contract with the same health plans as the facility or facilities they practice in, or through a prohibition on these physicians contracting with health plans or billing patients directly.”

Full Report: State Approaches to Mitigating Surprise Out-of-Network Billing

Adler Presentation Slides: Policy Approaches to Addressing Surprise Out-of-Network Billing

Panel Discussion: Policymaker

The Policymaker panel discussion was moderated by Mark Hall, Nonresident Senior Fellow of Economic Studies, Center for Health Policy.

Panelists included:

  • Jessica Altman, Commissioner Pennsylvania Insurance Dept.
  • Jane Bayer, Washington State Office of Insurance Commissioner
  • Lauren Block, Program Director-Health Division, National Governors Association
  • Marry Moody, Health Policy Advisor, Office of Senator Bill Cassidy

Panel Discussion: Stakeholders

Paul B. Ginsburg, Director of the USC-Brookings Schaeffer Initiative for Health Policy, moderated the stakeholder panel discussion.

Panelists included:

  • Claire McAndrew, Director of Campaigns and Partnerships, Families USA
  • L. Anthony Cirillo, Board Member, American College of Emergency Physicians
  • Molly Smith, VP of Coverage and State Issues Forum, American Hospital Association
  • Jeanette Thornton, Senior VP of Product, Employer, and Commercial Policy, America’s Health Insurance Plans

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