A year after Congress came up with a fix for surprise medical bills, health insurers, hospitals and doctors are still spending millions to tailor the fine print in their favor
The coalition supports the Biden administration’s interim final rule that instructs arbitrators to rely primarily on a single factor — the median in-network rate in a geographic area — when settling disputes between providers and payers. It has sponsored multiple six-figure digital ad-buys, including one that runs through Christmas, urging regulators to stay the course.
Provider groups contend that rules by the Department of Health and Human Services — which aren’t yet final — favor insurers, and they point tofrom HHS Secretary Xavier Becerra about providers that are "overcharging" as evidence of the administration's steadfastness. The figure "reflects the payment that similar providers who chose to contract are paid for those same services in that market," he adds.
“Being out of network is really the physicians’ only control over how their contracts look,” said Randall Clark, the president of the American Society of Anesthesiologists. “If the insurance companies can treat us the same whether we're in network or out of network, there is no impetus on the part of the insurance companies to negotiate fair contracts.”
The industry also takes issue with rules that treat all air ambulance services the same — lumping those which negotiate with insurers as part of a larger hospital system and those providers that negotiate independently together.Although industry voices have been the loudest throughout, patient groups and unions — including the American Heart Association, AFL-CIO and Families USA — have sided with the Biden administration’s interpretation of the law, saying it would keep costs and premiums down.
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