Insurers, hospitals spar over surprise billing: 8 things to know

As federal lawmakers work to reach a consensus on a surprise billing solution, insurers and hospitals are debating the issue.

Eight things to know:

1. Representatives of employees, large and small American businesses, health insurance providers and brokers sent a letter March 18 urging congressional leaders to act this year to pass legislation that will protect patients from surprise medical bills and reign in rising healthcare costs.

2. The letter — which was signed by nearly 20 groups, including America’s Health Insurance Plans and BlueCross BlueShield Association — said surprise billing legislation should protect patients by banning physicians from sending such bills to patients in situations of emergency, involuntary care, or situations where the patient was unable to choose their provider.

3. It also advocates for requiring that facilities notify patients of whether their physician is in the insurance company's network and potential options for receiving care from a different provider, without requiring patients to agree to out-of-network care.

4. Authors of the letter said surprise billing legislation should set reimbursement rates that won't increase premiums or affect access to care "by basing amounts on market rates determined by reasonable, contracted amounts paid by health insurance providers to similar doctors in a geographic area or a percentage of Medicare."

5. The authors said legislation should also make sure these protections apply to all health plans, including self-funded plans.

6. The letter opposes using arbitration processes that can keep patients in the middle of disputes between the service provider and insurer and result in higher coverage costs.

7. Commenting on the letter, AHA President and CEO Rick Pollack and Federation of American Hospitals President and CEO Chip Kahn said, "Beyond protecting patients and ensuring adequate health plan provider networks, it is essential that insurers and providers of care retain the ability to negotiate appropriate payment rates. Not only is it a dangerous precedent for the government to start setting rates in the private sector, but it could also create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks."

8. Six national healthcare groups, including the AHA and the FAH, last month penned their own letter to Congress outlining principles for lawmakers to consider amid their efforts to eliminate surprise billing.


More articles on healthcare finance: 

For-profit hospital stock report: Week of March 11-15
MACPAC seeks more gradual phase in of Medicaid DSH cuts
Montefiore Medical Center's annual operating margin slightly declines


Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars