The 2020 session of the Indiana General Assembly may be over, but physicians remain committed to improving one bill in particular: House Enrolled Act (HEA) 1004 (P.L. 93-20) to end surprise medical billing. It was the last piece of legislation lawmakers considered. 

Legislators had good intentions when they vowed to end surprise billing. And, ISMA stood with them in support, urging Gov. Eric Holcomb and lawmakers in both chambers to develop a solution that fully protected patients from surprise bills sent by out-of-network providers and included a process for physicians to negotiate fair payment with insurers.

Unfortunately, despite intense lobbying efforts to include an independent dispute resolution (IDR) process, HEA 1004 passed without a mechanism to ensure fair payment for physicians.  

Instead, the law leaves independent physicians at the mercy of insurers, who can reimburse out-of-network physicians at any amount they decide, and unintentionally motivates insurers to push more providers out of network. While legislators initially sought greater transparency, the final bill also failed to curtail the practices of insurance plans, which determine out-of-network reimbursement rates for medical procedures behind closed doors. This means physicians have no idea what rates are being charged for their services and have no way to challenge the reimbursement rate. 

As a result, the new law will likely be one of the most insurance-friendly surprise billing laws in the nation when it takes effect July 1, and ISMA is continuing to study its potential impact. Its passage could have serious, unintended consequences for independent physician groups in Indiana and create further consolidation of the health care market at a time when Hoosiers need greater access to care, not less.

In addition, the General Assembly did nothing to take patients out of the middle. Rather than removing patients from the often-confusing billing process, the new law leaves them stuck between their insurance company and each doctor on their medical team. 

It is worth noting that emergency services were exempted from HEA 1004’s prohibition on balance billing, so emergency physicians and others who respond to emergencies, such as on-call specialists, will not be affected by the new law.
  
What can you do?
The ISMA Government Relations team will continue to educate lawmakers about the impact of this legislation. We need members to track the adverse impact of the changes on physician practices and help us build the base of evidence that ISMA will need to introduce solutions in 2021.

ISMA has reached out to several specialty societies to collect their physicians’ experiences stemming from the new law. If you have not provided your input via a specialty society, and you have input you wish to share, please e-mail Luke McNamee, deputy director of policy, at lmcnamee@ismanet.org.   

The results of your feedback will be analyzed over time and will be useful in the GR team’s conversations with legislators. It will take all of us working together to protect patients from surprise billing, as well as legislators being receptive to our recommendations, to improve health care in Indiana for everyone.