Save the Date!

Wednesday, May 2, 2018 is MACEP's Annual Meeting to be held at the Massachusetts Medical Society Conference Center, Waltham, MA

Action Alert

DECEMBER 2017 CALL TO ACTION
 

 

CALL YOUR STATE REPRESENTATIVE IN SUPPORT OF FAIR HEALTH INSURANCE COVERAGE  

S.2211, the omnibus Senate Health Care bill contains Out of Network (OON) provisions that are strongly opposed by MACEP. 

The Senate bill would allow insurers to reimburse non-contracted commercial OON claims at “not more” than the 80th percentile of an insurance charge database for the next 2 years and then empower the Health Policy Commission with arbitrarily setting our rates moving forward. The House will likely take up the issue of health care cost containment and OON in early 2018 so the time to provide feedback is now.  
 
MACEP needs your help as we advocate for fair insurance coverage for our patients by taking this next month to educate our State Representatives about Senate Bill 2211.
 
Please, take 5 minutes to call or email your State Representative.
Contact information can be found here: (https://malegislature.gov/Search/FindMyLegislator).
 
Tell them you are a constituent and practicing Emergency Physician, and:
 
"I am calling to discuss S.2211, An Act Furthering Health Empowerment and Affordability, the omnibus Senate Healthcare Bill that passed the Senate this November. I want to alert the House to concerning language in Section 118 that sets a ceiling for non-contracted or OUT OF NETWORK health care coverage. 

While the numbers of patients affected by non-contracted rates is very small, the effect is much larger and could potentially lead to closure of emergency departments in the Commonwealth.
 
The Senate's language gives a non-contracted payment ceiling of NO MORE THAN the 80th percentile of an insurance charge database (e.g. the Fairhealth.org database). Doing so gives the insurance companies permission to provide less healthcare coverage for our patients. 

Setting this ceiling also means an insurance company could choose to pay an emergency department unfair rates for emergency care such as taking care of a heart attack or stroke or asthma attack or broken bone, all without any recourse or fair negotiation.
 
Allowing insurance companies to unilaterally set rates without a guaranteed floor or minimum fair payment will affect all emergency departments: those run by private/independent groups, those who's physicians are hospital employees, and those that staff from a larger contracting body.  This bill, as currently written, will allow insurers to ratchet down payments to all Emergency Departments regardless of how it's emergency physicians are employed.

Emergency physicians support implementing the Connecticut model for OON reimbursement, which requires the use of an independent and transparent charge database, such as the Fair Health Database (www.fairhealth.org) to determine usual, customary and reasonable rates, establishes a dispute resolution process for providers and patients, and which would eliminate high charge outliers by setting the default OON rate at (not below) the 80th percentile.
 
To paraphrase my professional college's immediate past-president, Dr. Becky Parker, as America’s healthcare safety net, emergency departments and emergency physicians stand ready 24/7/365. We rely on fair coverage to keep our doors open. Patients need us, and they deserve fair health insurance coverage from the insurance industry."
 
PLEASE CALL OR EMAIL YOUR STATE REPRESENTATIVE NOW!
This issue will not be decided tomorrow. Why should you call now?  The goal is for MACEP members to establish a “relationship” with your Representative - one in which over the next few months, they become familiar with the unique nature of emergency medicine and the importance of this issue to their local hospital and to their community.   
Please report back to MACEP any relevant feedback from your Representative or his or her Legislative Aide.  
Thank you!

 For further information/education, review ACEP's FAIR COVERAGE sheet.