Fighting for Fairness—for Physicians and Patients

Out-of-pocket healthcare costs continue to rise, while insurance coverage narrows. The cost of providing care is going up, while reimbursements are going down. This is unsustainable—for patients, for providers, for our nation’s healthcare system.

Though the Affordable Care Act ensured that millions more Americans receive healthcare coverage, rapidly increasing premiums, network inadequacy and exceptionally high deductibles of $5,000 and up often leave consumers with little real usable coverage, except in times of catastrophic need.  

Worse yet, when emergency care is needed, consumers often go to—or are taken to—the nearest hospital, not knowing or thinking about whether they are entering an in-network facility or will be cared for by an in-network physician. In some cases, an insurance carrier will have unexpectedly narrowed their network without timely notice to the patient or the physician. Later, when the patient receives a bill for out-of-network services, they are completely surprised by the coverage gap. There is little transparency.

Recognizing that the current path is unsustainable, physicians nationwide are coming together, not just as advocates for each other, but more importantly, as advocates for their patients. Physicians for Fair Coverage (PFC) was recently established as a non-profit advocacy organization for thousands of physicians from a multitude of specialties, including radiology, emergency care and anesthesiology.

Our mission is to achieve better and fairer healthcare coverage for all, and to improve patient protections. Specifically, PFC is working to:

• improve network adequacy to allow for greater patient access to emergency, specialty and hospital-based care;
• create better and timely transparency regarding who the in-network physicians for any insurer are, what the costs are of the services provided and how payments are calculated, with immediate notification of changes to both consumers and physicians; and
• establish a fair and reasonable minimum benefit standard that can significantly reduce the need to balance bill, if not eliminate it altogether.

PFC and partner organizations believe no insurance plan is adequate if patients lack coverage when they need it most. Providing a minimum benefit standard for out-of-network care would, at the very least, ensure affordable access to quality emergency services without patients having to worry about an unexpected financial burden. Consumers will feel secure knowing they are definitely covered for care before they unexpectedly become patients.

At this time, though many state legislatures are currently out of session, there are lawmakers working behind the scenes to draft legislation—with support of the insurance industry—that eliminates balance billing, without any consideration for the real problem, which is a lack of adequate insurance coverage. If passed, this will leave physicians with payments far below the costs of providing what is often lifesaving care.

PFC is offering an alternative. Our solution is model legislation that will create fairer healthcare coverage and better protections, ensuring access to quality, affordable care when it’s needed most.

We hope you will consider joining us, adding your voice to ours as we advocate for real change in the healthcare system. As a non-profit, non-partisan growing alliance of multi-specialty physician groups, we can and will work together to educate and advocate. Our patients are depending on it.