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


What’s new: The Biden administration did issue a second provisional final rule (IFR) to implement the No Surprises Act, which will come into force in January, but unfortunately it is an undeserved gift to the insurance industry that will limit health care opportunities for patients.

The IFR “ignores the intentions of Congress and contradicts the stated concerns of the Biden administration about the consolidation of the health care market,” said AMA President Gerald A. Harmon, MD. “It disregards the role of the insurance industry in creating the problem of Surprise billing at the expense of resident medical practices, whose ability to negotiate contracts with provider networks continues to erode. “

Congress had “properly understood the negative effects of national pricing on health services and put a lot of time and effort into developing a robust independent dispute settlement process to maintain market balance and access to health care, which the administration apparently ignored,” added Dr. Harmon. added, a family doctor in South Carolina.

“It is also evident that the administration has failed to recognize the importance of creating accessible and impartial dispute settlement procedures as a back-up against even greater abuse by insurers,” said Dr. Harmon.

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Do not distort any surprising accounting rules in favor of the health insurance companies

Why it matters: This surprisingly accounting IFR comes just a few days after the AMA released the latest annual edition of “Health Insurance Competition: A Comprehensive Study of US Markets“(PDF), with results showing the rise of highly concentrated health insurance markets. This year’s study showed that, according to the federal government’s own guidelines, an astonishing 73% of the country’s insurance markets can be classified as “highly concentrated”. The result is higher premiums and closer networks of providers, which are a major cause of the surprising medical billing problem.

The AMA urges the Biden government to delay implementation and allow a full assessment of the measures in the tentative definitive regulation that have negative long-term effects on patients and the healthcare system.

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New surprise billing law on the way: What doctors need to know

Learn more: Earlier this year, the Biden government issued its first IFR to implement other elements of the No Surprises Act. read this Analysis of AMA and discover why surprising billing rules shouldn’t target health insurance companies.

Patients, doctors and policy makers are deeply concerned about the patient costs caused by tight networks of providers. When patients have to leave the network to receive insured care, they are often burdened with unexpectedly high medical bills.

The AMA supports patient protection from unexpected medical bills, and stricter regulation of the provider network to ensure fair pay for doctors outside the network. Find out, Six ways insurers are driving the surprise billing phenomenon.

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