How the latest surprise billing rule strengthens the power of health insurers


What are the news: The Biden administration has published a second provisional final rule (IFR) to implement the No Surprises law which will come into effect in January, but this unfortunately represents an undeserved giveaway to the insurance industry that will narrow healthcare options for patients.

The IFR “ignores the intention of Congress and flies in the face of concerns expressed by the Biden administration regarding the consolidation of the health care market,” said the president of WADA. Gerald A. Harmon, MD. “This ignores the role of the insurance industry in creating the problem of surprise billing to the detriment of independent medical practices whose ability to negotiate supplier network contracts continues to erode.

Congress correctly understood “the negative consequences of domestic pricing for health services and devoted considerable time and effort to developing an independent and robust dispute resolution process to maintain the balance of the market. market and preserve access to care, which the administration has apparently ignored, ”added Dr Harmon. , family doctor in South Carolina.

“It is also evident that the administration failed to understand the importance of creating accessible and impartial dispute resolution processes as a safety net against even greater abuse by insurers,” said Dr Harmon.

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Don’t distort surprise billing regulations in favor of health plans

Why this is important: This surprise billed IFR comes just days after WADA released the latest annual edition of “Competition in health insurance: an in-depth study of the US markets(PDF), with results demonstrating the rise of highly concentrated markets for health insurance. This year’s study found that 73% of the country’s insurer markets can be classified as “highly concentrated,” according to the federal government’s own guidelines. The result is higher premiums and tighter supplier networks, which are the root cause of the surprise medical billing problem.

WADA urges the Biden administration to delay implementation and allow a full assessment of interim final rule policies that have long-term negative implications for patients and the healthcare system.

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New Surprise Billing Law: What Doctors Need to Know

Learn more: Earlier this year, the Biden administration released its first IFR to implement other elements of the No Surprises Act. Read it AMA’s analysis and discover why surprise billing regulations shouldn’t be geared towards health plans.

Patients, physicians, and policy makers are deeply concerned about the costs to patients caused by tight provider networks. When patients have to leave the network to receive covered care, they are often burdened with surprisingly high medical bills.

WADA supports patient protection against unforeseen medical bills, and stricter regulations on provider networks to ensure fair payment to non-network physicians. Discover the six ways insurers are driving surprise billing.

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