Four congressional leaders who negotiated surprise billing legislation that was left out of Congress' year-end spending deal have expanded an investigation of balance billing practices to include insurers and physician staffing companies.
Senate health committee Chair Lamar Alexander (R-Tenn.), health committee ranking Democrat Patty Murray of Washington, House Energy & Commerce Chair Frank Pallone (D-N.J.) and Energy & Commerce ranking Republican Greg Walden of Oregon on Thursday said they will home in on whether insurance companies refuse to negotiate reasonable reimbursement rates with some providers and on physician staffing companies' policies on sending patients surprise medical bills.
"We started today to continue to expand our investigation into these corporations that have now purchased physician practices, as well as insurance companies to find out why this is happening so that we can better prepare for how to stop it," Pallone said Thursday on MSNBC.
Insurers and provider groups have been pitted against each other in the debate on surprise billing, and bipartisan, bicameral legislation that hospital and provider groups opposed failed to make it across the finish line with Congress' year-end spending deal this month.
The letter recipients included Envision Healthcare, TeamHealth, Anthem, Cigna Corp., CVS Health, Health Care Service Corp., Highmark and UnitedHealth Group.
The letters to insurers seek the number of beneficiaries that have been responsible for paying for out-of-network care in an in-network facility, reimbursement rates paid to physicians who are affiliated with a physician staffing company and those who aren't, and how insurers inform beneficiaries about potential costs for care provided by out-of-network providers.
Lawmakers requested information from physician staffing companies about how they determine in-network and out-of-network rates, the percentages of physician services provided at in-network and out-of-network rates, and discussions among executives about how surprise bills factor into revenue.
Pallone and Walden in September sent letters to the CEOs of Kohlberg Kravis Roberts & Co., the Blackstone Group and Welsh, Carson, Anderson & Stowe seeking detailed financial evaluations of the physician-staffing companies and air and ground ambulance companies owned by these firms.
A spokesperson for Pallone said the lawmakers have received responses from the private-equity companies, but the inquiry is ongoing.
Congress will continue to debate competing surprise billing proposals in 2020.