State Beat  |   January 2017
Insurance Gaps Root Cause of Out-of-Network Payment Issues
Article Information
State Beat
State Beat   |   January 2017
Insurance Gaps Root Cause of Out-of-Network Payment Issues
ASA Monitor 01 2017, Vol.81, 54-55.
ASA Monitor 01 2017, Vol.81, 54-55.
On October 13, then-ASA President-Elect Jeffrey Plagenhoef, M.D., spoke at the Brookings Institution forum, “Protecting Patients from Surprise Medical Bills.” The think tank briefing was timed with the release of a Brookings policy paper on this topic and featured two panels: stakeholder and policymaker perspectives.
During the stakeholder panel, Dr. Plagenhoef explained that balance billing is a symptom of a much larger problem and pointed to “gaps in insurance coverage” as the root cause. Much like with the treatment of disease, he explained, it is insufficient to merely treat the symptoms. Instead, a comprehensive approach that includes “accessible networks with an adequate number of all providers and all services, as well as a mechanism for fair out-of-network payment,” is key to solving this multi-faceted issue.
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