Healthcare administration specialist Dr. Pachavit Kasemsap serves as medical director manager in utilization management of Cigna, where he is responsible for completing utilization management determinations and assisting with appeals when necessary. Board-certified by the American Board of Surgery, Pachavit Kasemsap, MD is a Fellow of the American College of Surgeons (ACS).
ACS has raised concerns about the impact of surprise medical bills on the patient-physician relationship. In urging the legislators for a comprehensive solution to the issue, ACS maintains its position that patients should not be caught up in the middle of payment negotiations between healthcare insurance providers, physicians, and hospitals.
ACS provided lawmakers with the physician’s perspective on the issue since lawmakers have been forging legislative proposals to eliminate out-of-network care surprise medical bills since last year. ACS said that any future bills that will tackle the issue should protect the patients. Legislation should also increase transparency and accountability of insurance plans, and address inadequate networks. Additionally, ACS believes that legislative solutions to the issue should not put reliance on rate-setting based on negotiated in-network rates. Neither should the solution depend on a percentage of Medicare to cover out-of-network care.
These suggestions are important considerations and if the members of Congress do not heed these inputs, ACS expects large-scale effects on the healthcare system. For the solution to surprise medical bills to be sustainable, physicians and insurance providers should implement a fair independent dispute resolution process to negotiate final payment.
Pachavit Kasemsap 