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A law passed by Congress to end one of the most hated practices in US medicine – surprise billing – has become a behind-the-scenes battleground between doctors and insurers.
The No Surprises Act was passed in 2020 in a rare bipartisan effort to end so-called surprise or balance billing – a practice where healthcare providers who do not have contracts with insurance companies charged patients directly for hundreds or thousands of dollars.
“One of the important things to remember is the core purpose of the law was to protect consumers from getting these surprise balance bills,” said Jack Hoadley, an emeritus research professor at the Health Policy Institute of Georgetown University. “That part of the law is actually working quite well by all indications.”
But litigation and aggressive billing by physician staffing companies, some backed by private equity, have continued as insurance companies and doctors duke it out in court. The result is an enormous backlog of cases in arbitration, cashflow problems for independent doctors, and the potential for patients to once again be stuck with the costs. Some argue that there’s also a balance of power tilted toward insurance companies.
Notably, surprise bills often arrive after emergency situations. Ambulances, emergency room doctors and anesthesiologists are among the most likely to send such unwelcome statements.
With patients unable to choose a physician for most emergency services, private equity-backed physician staffing agencies became key players in surprise billing. Companies stayed out-of-network for all or most insurance plans, which allowed patients to inadvertently see doctors not coveredby insurance (“out-of-network”) even at hospitals that insurance approved. As a result, staffing companies in effect charged patients whatever they wanted after the fact…….
www.theguardian.com
The No Surprises Act was passed in 2020 in a rare bipartisan effort to end so-called surprise or balance billing – a practice where healthcare providers who do not have contracts with insurance companies charged patients directly for hundreds or thousands of dollars.
“One of the important things to remember is the core purpose of the law was to protect consumers from getting these surprise balance bills,” said Jack Hoadley, an emeritus research professor at the Health Policy Institute of Georgetown University. “That part of the law is actually working quite well by all indications.”
But litigation and aggressive billing by physician staffing companies, some backed by private equity, have continued as insurance companies and doctors duke it out in court. The result is an enormous backlog of cases in arbitration, cashflow problems for independent doctors, and the potential for patients to once again be stuck with the costs. Some argue that there’s also a balance of power tilted toward insurance companies.
Notably, surprise bills often arrive after emergency situations. Ambulances, emergency room doctors and anesthesiologists are among the most likely to send such unwelcome statements.
With patients unable to choose a physician for most emergency services, private equity-backed physician staffing agencies became key players in surprise billing. Companies stayed out-of-network for all or most insurance plans, which allowed patients to inadvertently see doctors not coveredby insurance (“out-of-network”) even at hospitals that insurance approved. As a result, staffing companies in effect charged patients whatever they wanted after the fact…….
Doctors and insurers clash over US law that protects against surprise billing
Private equity-backed staffing companies are fighting No Surprises Act, which protects patients from unexpected out-of-network bills
) whose love is riding horses. To say we're grateful does not begin to scratch the surface. It was touch and go there for awhile.
