The Arizona Medical Association (ArMA) is considering a state ballot measure to remove a key provision of the No Surprises Act (NSA), in order to boost fees of out-of-network physicians. The NSA is a federal law protecting patients from surprise medical bills, which went into effect January 2022. Balance billing is the term in industry parlance for surprise medical bills. Balance billing occurs when out-of-network physicians (who patients could not avoid) charge fees higher than what their health plans reimburse. Prior to the NSA, patients were responsible for any portion of out-of-network fees their insurers did not pay. The ArMA does not wish to gut so-called patient protections. However, the ballot measure would result in higher fees and higher premiums for consumers nonetheless. More on this below.
Surprise medical bills are unfair to patients and health plans alike. Health plans try to steer patients to providers who have agreed to specific terms and have negotiated fee agreements with a network. Selecting network providers reduces patient cost-sharing and in some health plans out-of-network care is not covered at all. Thus, patients have a strong financial incentive to seek care within their network.