Benchmark payments give insurers edge in surprise-billing disputes, ortho surgeons say

Using benchmark payments set by the federal government to settle out-of-network surprise-billing disputes is a sure way to give insurers the upper hand in healthcare marketplace negotiations, an association of orthopedic surgeons contends.

The association representing 34,000 orthopedic surgeons and residents sent a letter to the House Energy and Commerce Health Subcommittee, which has scheduled markup of the proposed "No Surprises Act" on July 11.

In the letter, the association said it is against benchmarking to median in-network rates to resolve out-of-network payment disputes between providers and health plans.

"This approach would result in an unprecedented transfer of market power to insurers by sanctioning government mandated price-setting," wrote Wilford Gibson, MD, chair of the association's council on advocacy.

The association is against benchmarking even if rates are associated with the Consumer Price Index for All Urban Consumers, a suggestion in the "No Surprises Act," he added.

Instead, the group called on the subcommittee to amend any legislative surprise-billing proposal to include arbitration.

Dr. Gibson wrote: "Arbitration is the only model that has proven to effectively reduce the number of out-of-network bills while maintaining a fair playing field between physicians and insurers. It is also the only approach that fixes unexpected out-of-network medical bills without negatively impacting the economics of the health care market."

Read the full letter here

 

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