Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE +
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Opinion
January 21, 2022 12:00 PM

Insurers already exploiting the surprise billing law

Dr. Gillian Schmitz
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Schmitz Headshot 2021 copy_i.jpg
    Dr. Gillian Schmitz is president of the American College of Emergency Physicians.

    Congress passed the No Surprises Act last year to protect patients from surprise medical bills. This bipartisan legislation was on its way to being celebrated as a victory by all involved—something increasingly rare in Washington, D.C., these days. Unfortunately, insurance companies are already exploiting the way the Biden administration is implementing the law.

    The American College of Emergency Physicians (ACEP) supports the patient protections in the No Surprises Act, but the law's implementation language completely ignores congressional intent to create a fair independent dispute resolution (IDR) process.

    While the law instructs the arbiter of the IDR process to consider all information shared by the insurer and physician, the administration made the qualified payment amount, a subjective rate set by insurers, the primary factor in the process. This sets an artificially low benchmark payment that insurers can use to drive their payments even lower and push more physicians out-of-network.

    As soon as the administration announced its plan, emergency physicians received a chilling letter from Blue Cross Blue Shield of North Carolina, threatening to end their agreement to be in-network unless the physicians accept a 20% cut in reimbursement for necessary medical care. Why the sudden change? Blue Cross Blue Shield directly cites the implementation of the No Surprises Act as its rationale.

    Similarly, UnitedHealthcare is attempting to bully physicians to accept a 40% cut or they lose their contract. The American College of Emergency Physicians will keep alerting legislators about these strong-arm tactics because insurance companies will continue unless they are stopped.

    It is important to understand how these tactics impact patients. Emergency departments, especially those in small or rural communities, will be forced to make difficult decisions on how to spread already thin resources to continue to treat their patients. Options on the table include cutting staff, changing hours, and adjusting workloads so they can meet their legal obligation to stay open 24/7 and see every patient that comes through the doors—no easy feat in the middle of a pandemic when they're already understaffed and facing major professional burnout.

    Things have been tough for emergency physicians—especially those who run their own practices. Bad behavior by insurers—like canceling contracts and denying payment for services—continues to strain many physician-run groups already buckling under enormous pressure.

    Insurance companies aided by the regulatory language that guides NSA implementation are choosing policies that put emergency departments at risk of closing. That is heartbreaking, but more than that, it is dangerous. It is impossible not to worry about the safety of thousands of people, especially in small towns or underserved areas, where the next available emergency physician is hours away.

    In practical and immediate terms, the implementation of this law will diminish the ability of front-line professionals to treat patients during surges, whether that means caring for an influx of people with COVID, victims of a mass casualty event like a shooting, or helping people with heart attacks or drug overdoses.

    Download Modern Healthcare’s app to stay informed when industry news breaks.

    Insurance companies argue that cutting physician reimbursements will create opportunities to make insurance coverage more affordable for everyone. However, year after year insurers rake in profits while the cost of employer-sponsored family health coverage goes up. According to the Kaiser Family Foundation, the financial burden of deductibles has increased by 92% in the past decade.

    The cuts facing emergency departments in North Carolina would be disastrous anytime, but they hurt a lot more in the middle of a pandemic when healthcare providers are already burned out, overworked, and facing increasing financial strain.

    Congress carefully crafted the No Surprises Act to create an unbiased process to resolve billing disputes. When the administration wrote the implementation rules, they fundamentally altered the compromise that all involved spent years negotiating. These dangerous revisions cannot stand.

    ACEP, the American College of Radiology, and the American Society of Anesthesiologists are taking legal action to reverse the federal government's last-minute changes. We will fight to ensure the No Surprises Act solves surprise bills as Congress intended, rather than allowing insurance companies to twist the legislation to benefit themselves—leaving patients and physicians in the cold.

    Related Articles
    Congressional doctors lead bipartisan revolt over policy on surprise medical bills
    Congress needs to address looming physician reimbursement cuts
    Physician groups lobby Congress for pay increase while seeing need for long-term reform
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    cvs health_i.png
    Oak Street Health shares soar on report of CVS deal
    physical therapy telehealth.png
    MSU Health Care unveils virtual physical therapy program
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE +
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing