American Academy of Emergency Medicine


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Take Action: Contact Your Representatives About Due Process and Balance Billing

Posted Monday, December 14th, 2015

Continued Advocacy for Our Members

Members of the AAEM board of directors met with lawmakers on Capitol Hill on December 10, 2015, to advocate for due process for emergency physicians and balance billing practices.

AAEM believes that emergency physicians must remain free of corporate influence because of their difficult role as advocates for the under and uninsured patient. AAEM firmly believes it is in the best interest of the patients to have emergency physicians unencumbered by the profit concerns of a corporation. AAEM supports physician-owned groups, which is the best model for professional satisfaction and quality of care.

Due Process for Physicians

Emergency physicians believe that due process is fundamental to our ethical mandate to care for patients without being pressured by administrative or other external influences. Due process is defined as a fair hearing with a right of appeal in front of peers on the medical staff prior to any alteration, restriction or termination of our privileges to practice medicine in a hospital. Emergency physicians necessarily serve as direct advocates for their patients, many of whom go to emergency departments because they are vulnerable due to medical, social or financial issues outside of their control. In some cases, such advocacy may conflict with non-patient-oriented forces placing the emergency physician at odds with the hospital or consulting physicians. Therefore, any contractual limitation on the due process rights of emergency physicians is not in the public interest as it hinders the ability of emergency physicians to act at all times in the best interest of the patient.

AAEM stands with the American Academy of Family Physicians (AAFP), the American College of Emergency Physicians (ACEP), the American Society of Anesthesiologists, the American College of Legal Medicine, the Emergency Medicine Resident’s Association, the Society of General Internal Medicine, the Council of Emergency Medicine Residency Directors, and others, in urging protection of the physician’s right to due process.


Balance Billing

Balance billing is the ability of physicians to bill patients for remaining balances after insurance has paid its share. Typically, this occurs when a practice elects to operate outside an insurer’s network, often because the contractual terms for participating in the network are financially inadequate.

In most cases, balance billing for elective procedures is prohibited. In part, this is because physicians and hospitals have the ability to refuse the negotiated rate for services based on the type of insurance held by the patient. However, emergency care must be provided to all patients under federal law (EMTALA). By denying emergency physicians the ability to bill patients for the cost of the procedure not paid by insurance, doctors have no recourse against reimbursements levels that are often severely inadequate. Balance billing is not a tool for emergency physicians to get extra money out of patients; it is the only means to receive fair compensation for emergency services they have provided.

There are ongoing efforts through legislation and regulation to completely prohibit balance billing. This would have disastrous consequences for patients and for the emergency department safety net. Without balance billing, insurance companies will have the ability to unilaterally set reimbursement rates for emergency medicine at well below market rates. In many rural areas, this could result in the collapse of the emergency care system. It will also drive quality providers out of the provision of emergency care across the country.


AAEM Board of Directors on Capitol Hill 

AAEM Board Members (clockwise from the top) David Farcy, MD FAAEM FCCM; Jonathan S. Jones, MD FAAEM; Lisa Moreno-Walton, MD MSCR FAAEM; Leslie Zun, MD MBA FAAEM; David Lawhorn, MD FAAEM; Andy Walker, MD FAAEM; Kevin Rodgers, MD FAAEM; Mark Reiter, MD MBA FAAEM; and Andy Mayer, MD FAAEM 


AAEM Board Members (L-R) David Farcy, MD FCCM FAAEM; Robert Suter, DO MHA; John Christensen, MD FAAEM; Jonathan S. Jones, MD FAAEM and Representative Pete Sessions (R-TX), second from left


AAEM Immediate Past President, William T. Durkin, Jr., MD MBA CPE FAAEM and Representative Barbara Comstock (R-VA)