The white paper was written as part of a partnership between the Center for Health Policy at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics, the USC-Brookings Schaeffer Initiative for Health Policy.
The first state option is a billing regulation approach. States using it would:
- Limit out-of-network charges. This limit would be equal to a multiple of the relevant Medicare rate “in line with what nonemergency or ancillary specialists with similar training are paid by commercial payers,” the authors write.
- Require fully insured health plans to not put beneficiaries on the hook for cost-sharing beyond normal in-network cost-sharing amounts for out-of-network services
- Apply these rules to out-of-network emergency services as well as out-of-network ancillary clinician, hospitalist and neonatology services delivered at an in-network facility
The second state option from the white paper is a hybrid billing regulation/contracting regulation approach. Under this option, states would implement the billing regulation approach for out-of-network ambulance services and emergency services delivered at an out-of-network facility.
States using the hybrid approach also would prohibit independent billing for emergency, ancillary clinician, hospitalist and neonatology services delivered at in-network facilities.
“By enacting either of these approaches, states could largely protect all privately-insured state residents from surprise out-of-network bills, regardless of whether they are enrolled in a fully- or self-insured health plan,” the authors concluded.
“And by eliminating the lucrative out-of-network billing option for ED [emergency department] and ancillary physicians, these approaches could also reduce healthcare spending and insurance premiums,” the authors said.
More articles on healthcare finance:
US health spending estimated to reach nearly $6 trillion in 8 years
National healthcare groups outline surprise-billing principles
California proposed health-pricing transparency bill would affect Kaiser Permanente
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
