ENVISION HEALTHCARE:
PUTTING THE PATIENT FIRST

Working Together to Protect the Patient

We are proud of our physicians and the excellent services they provide. We believe that no patient seeking quality care should be caught in the middle of discrepancies between providers and insurance companies – no matter the circumstance. That is why we are working with insurance companies and legislators in a productive and fair manner to make sure patients are not burdened by unexpected bills that they cannot pay or that prevent them from seeking the additional care they need because their health benefits do not provide the coverage they expected.

Insurers Continue to Shift Costs to the Patient

We know there are challenges with the current healthcare reimbursement system, and there are a number of driving forces behind the widespread problem:

The balance of power currently rests with the insurance companies, who often refuse to use an independent and transparent system to determine reimbursement rates
Insurance companies leverage overly narrow networks, a tactic designed to increase their profits
Insurance companies regularly shift additional costs to patients by selling high-deductible plans without explaining potential surprise gaps in coverage to the patient
Insurance companies use the imbalance of power in contracting to take unilateral reductions in negotiated payment rates

Under the Affordable Care Act and the Emergency Medical Treatment and Active Labor Act, an unfunded mandate, emergency patients are required to be seen, regardless of ability to pay. Coupling this with the insurance industry raising deductibles and arbitrarily reducing reimbursement has caused the issue of surprise billing. Patients seeking quality care – particularly emergency care – should not have to fear surprise gaps in insurance coverage as a result of current practices by insurance companies that have put them in the crosshairs. We are working to be part of a solution that makes sure patients are not burdened by unexpected bills, which may put them in financial distress.

An Independent Charge Database

To prevent gaps in coverage due to out-of-network billing, it is critical that we use a fair and independent charge database. This will make it so that doctors are fairly compensated and able to provide quality care to patients across the country.

Federal Legislation

We support language in the House Appropriations bills calling on the Center for Consumer Information and Insurance Oversight to clarify the method of determining usual, customary and reasonable (UCR) payments using a transparent and fair standard, such as an independent, unbiased charge database. The term “usual, customary and reasonable amount” is defined as the 80th percentile of all billed physician charges for the particular healthcare service performed by a provider in the same or similar specialty and provided in the same geographical area as reported in either the FAIR Health database or another database approved by the Department of Health and Human Services.

The database must contain sufficient data for the geographic area, be publicly available and be maintained by an independent, nonprofit organization that is not financially sponsored or organizationally affiliated with an insurance carrier, group health benefits plan or administrator or payor of health insurance claims.

Model Legislation

As providers, our first priority is always our patients. This is why we are committed to providing the highest quality of care without any surprises in regard to billing. To address this issue, we have joined with Physicians for Fair Coverage (PFC) to support proactive model legislation.

The Patient Protections and Transparency Act of 2018

Ends the surprise insurance gap
Establishes a Minimum Benefit Standard
Streamlines reimbursement to the healthcare professional
Ensures the health insurance company reimburses the healthcare professional
Ensures that cost-sharing payments to the healthcare professional will be treated by the health insurance company as though they were paid to an in-network healthcare professional

The National Council of Insurance Legislators (NCOIL) also introduced model legislation that supports many of the issues addressed by PFC.

Out-of-Network Balance Billing Transparency Model Act

Requires improved network transparency
Ensures patients are held financially harmless for out-of-pocket costs beyond in-network cost-sharing
Requires that physician reimbursement be tied to 80th percentile of an independent benchmarking database maintained by a nonprofit organization

Additional Resources

Envision Is Going In-Network

The health and well-being of our patients are at the core of everything we do – both clinically and in regard to our business practices. To protect patients, Envision has committed to going in-network. Currently, more than 90 percent of our business comes from treating patients who are in-network.

Envision Cares for Patients Across the Healthcare Continuum

Envision Healthcare is a national physician-led organization that works alongside clinicians, hospitals, health systems and insurance companies in our pursuit of creating healthier communities.

Our breadth, scale and scope of services are unparalleled. We care for patients across the healthcare continuum and coordinate care across multiple specialties. We are constantly developing industry-leading best practices to improve the quality and coordination of care while reducing costs.

ENVISION HEALTHCARE:
TOUCHING THE LIVES of 30 MILLION PATIENTS EACH YEAR