Senators Amy Volk and Rodney Whittemore with Gwen Simons, NEPPN Executive Director

NEPPN Members with Senators Volk and Whittemore

The NorthEast Private Practice Network recently recognized Senators Amy Volk and Rodney Whittemore and Representative Heather Sanborn with the Friend of Private Practice Award.  All three of these legislators sponsored and/or supported legislation LD 445, “An Act To Encourage Maine Consumers To Comparison-shop for Certain Health Care Procedures and To Lower Health Care Costs,” which will make health care costs more transparent and improve patient access to low cost, quality health care providers offering “shoppable” services.

As of January 1, 2018, the new law, known as “Right-to-Shop,” requires health care entities making a referral to inform patients of their right to obtain services from a different provider and give patients certain information in writing about available price transparency tools so patients can comparison shop.  In addition, beginning January 1, 2019, health plans (excluding HMOs) governed by state law will be required to cover pay for shoppable services (including out-patient physical and occupational therapy) provided by out-of-network providers when the cost is the same or less than the average cost the insurer would pay to in-network providers.

“Patients don’t always realize they have the power to choose where they go for out-patient services or that they may pay 2 or 3 times more for the same services if they choose a high-cost provider,” said Gwen Simons, NEPPN Executive Director. “This new law will give patients the information they need to be more responsible health care consumers.  Many out-of-network private physical therapy practices still charge less than their in-network hospital competitors, but patients are punished with higher copays/co-insurance and separate out of network deductibles when they choose an out-of-network provider.  This makes no sense.  If we are going to control health care costs, we need to encourage patients to shop cost-effective care, not punish them.  We appreciate the hard work of these Maine legislators in bringing some common sense back to our health care system.”

Senator Whittemore said, “I am absolutely honored to be recognized by NorthEast Private Practice Network for my work to get Right-to-Shop legislation over the finish line in Maine. With this new law, consumers will have more options when seeking quality healthcare and incentive programs will encourage consumers to consider cost when shopping for certain routine care and procedures. It’s a win-win premise that is sure to save money – for consumers and health plans alike.”

Senator Volk said, “Healthcare is the only major purchase that we make as Americans without first looking for the best deal, and that’s because our current system doesn’t incentivize shopping around for services. But often times, there can be a wide variation of cost for identical services between facilities, even within the same geographic areas. This results in higher costs to consumers and insurers, and in turn, higher premiums for healthcare plans. I was glad to lend my support to this common-sense legislation and am hopeful that it will improve medical services in Maine.”