\n\n“The law, which takes effect Jan. 1, protects patients from receiving expensive bills for unexpected out-of-network care but doctors, hospitals and insurers are still at odds over which factors an independent arbitrator should rely on to decide who picks up the tab.<\/p>\n\n\n\n
The outcome could swing billions of dollars in payments, significantly influence how doctors and hospitals negotiate prices with insurers and possibly affect premiums for millions of Americans.<\/p>\n\n\n\n
\u201cThis is probably one of the most significant overhauls in the health system since the [Affordable Care Act] ACA,\u201d said a spokesperson for the Coalition Against Surprise Medical Billing, which represents insurers, employer and union groups, and works with patient groups. \u201cWe certainly don’t see any end in sight in terms of the battle in making sure that these regs are implemented.\u201d<\/p>\n\n\n\n
The coalition supports the Biden administration\u2019s interim final rule that instructs arbitrators to rely primarily on a single factor \u2014 the median in-network rate in a geographic area \u2014 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.”<\/p>\n\n\n\n
…<\/p>\n\n\n\n
“Hospitals and doctors allege the Biden administration\u2019s decision to emphasize the median in-network rate, a figure the insurance companies calculate, gives large insurers a huge advantage when negotiating how much a service should cost.<\/p>\n\n\n\n
Insurers would have an incentive to keep the in-network rates lower to avoid paying more to out-of-network doctors. And they say payers would know doctors and hospitals have little recourse if they choose to remain outside an insurer\u2019s network.<\/p>\n\n\n\n
\u201cBeing out of network is really the physicians\u2019 only control over how their contracts look,\u201d said Randall Clark, the president of the American Society of Anesthesiologists. \u201cIf 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.\u201d<\/p>\n\n\n\n
Trade groups representing providers say the law lists several other factors that should be equally weighted when calculating how much a service costs, such as the doctor\u2019s experience and the complexity of the procedure. While these metrics can still be introduced during thedispute resolution process, the Biden administration\u2019s rules don\u2019t give them as much weight as the median in-network rate metric, which providers say puts them at a disadvantage before the process even begins.”<\/p>\n\n\n\n