Congress In California Has To Solve Two Poison Pills In Surprise Billing Legislation_ CMA Is In Action

Surprise Billing Legislation

Surprise Billing Legislation

CMA (California Medical Association) is urging Congress to fix two poison pills in surprise billing legislation. On 11 Dec 2020, a new bipartisan, bicameral proposed to resolve the very significant issue related to surprise medical billing.

Although, the state government has introduced “The No Surprise Act” to take action against the fraudulent acts of surprise medical billing. However, the act came into being a few days before the 116th Congress adjourns.

That day, CMA sent a letter of gratitude to the California Congressional Delegation. In that letter, they appreciated them for their contributions to the substantial improvements made to the bill. However, they also mentioned their concerns about the actions that are required to mitigate the acts of surprise medical billing. They wanted to make sure that every surprise billing legislation is fair and balanced.

Moreover, they always wanted to ensure that patients can easily access the physicians’ services. Also, it allows patients to deal with powerful healthcare insurance companies so they can fairly contract with physicians.


The primary objective of this movement is to protect patients from surprise medical bills. It is the main concern of CMA to ensure that nothing can stop patients from getting access to the safety net of emergency and specialists. Since they are responsible to take care of the patients in emergencies. Also, they should be available in their hospitals to take care of the patients at any time of the day.

CMA has been collaborating with the committees and government officials to make certain improvements in the “NO Surprise Act”. Despite these contributions, CMA has also decided to pay close attention to the two poison pills.

What Is The Concept Of Two Poison Pills?

The concept of two poison pills was included in the legislation to urge insurance payers to contract the resolution process. This process will create balance in the disputed matters.

This dispute resolution process also includes the Medicare and Medicaid rates. It has allowed insurance payers to submit payment rates for Medicare, Medicaid and other federal government programs to arbitration.

The purpose of this program is to meet the federal and state budget constraints. So the healthcare insurance companies do not reflect the commercial private market where ERISA plans operate.

Why Is CMA Urging Congress To Resolve Disputes?

Therefore, CMA is thrusting pressure upon Congress to only consider the rates of the commercial market in the dispute resolution process. This provision is quite unfair and also mark an impact on private market rates for in-network services. CMA is also focused to reduce the rates of the private payment sector. Because this move can also help physicians to better allocate their resources while struggling with the COVID-19 pandemic.

The purpose of the 90 days “Cooling-off period” is to oppose the proceeding of the dispute resolving process. While CMA supports the initial 30 days “open negotiation” process to informally settle claims. They are against the idea of a full-day 90-day cooling-off period. Because it ultimately allows insurance companies to remit payments to physicians before 165 days.

The real trouble is for the small and medium-sized physicians’ practices. As these practitioners operate on thin margins and they can’t wait for a longer time period of 5 months. If an insurer can wait for 165 days to pay the full medical claims. And they also have the payment factor for CMS beneficiaries. Then insurers don’t have a larger incentive in dealing with physicians this way.

Hence, CMA is trying to convince Congress to remove all the cooling-off period or reduce this period to only 30 days. This move will contribute a lot to protect the financial viability of physicians’ practices.

Flexibility For The Nation’s Physicians:

CMA is highly concerned that the government should launch the “NO Surprise Act”  on January 1, 2022. However, throughout this period our country’s physicians would be busy administrating the distribution of COVID-19 vaccination.

So physicians won’t get interrupted and they can play their role to improve the health and economic condition of the country. Although, the US government has already made great moves to protect patients from the surprise bills throughout the COVID-19 pandemic. CMA is urging Congress to shift the date back.

In this way, it’ll provide more time for physicians to recover and perform their administration duties to adjust to the new system. CMA has asked Congress permission to make changes to ensure balance in the bills.  They also have asked in the letter to reign-in the powerful for-profit insurers who’ve made record profits during the COVID-19 pandemic.

In this way, they can ensure the protection and safety of physicians who are fighting against the coronavirus. Certainly, it is the most important step to ensure the health of our nation during these critical healthcare crises.

Currently, this legislation is only applicable to federally-regulated ERISA employer-sponsored plans. So federal laws won’t hold state laws back from dealing with the issues of surprise bills, such as California’s AB 72.

Stay tuned for more updates about the legislative changes in the healthcare industry. Medical Billing Benefits is an informative platform and an insightful healthcare newswire. Subscribe to our E-Newsletter for the latest upgrades and news.

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