Insurers are already using the unexpected billing law

Last year, Congress passed the No Surprises Act to protect patients from unexpected medical bills. This bipartisan legislation was well on its way to a victory for all involved, an increasingly rare occurrence in Washington DC these days. Unfortunately, insurance companies are already exploiting the way the Biden administration implements the law.

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

While the law requires the arbiter of the IDR process to take into account all the information provided by the insurer and physician, the administration has made the qualifying payment amount, the subjective rate set by insurers, a major factor in the process. This sets an artificially low benchmark payment that insurers can use to lower their payments even further and push more doctors out of the network.

As soon as the administration announced its plan, ER doctors received a chilling letter from North Carolina’s Blue Cross Blue Shield threatening to terminate their network connectivity agreement unless the doctors agreed to a 20 percent cut in reimbursement for essential medical care. Why the sudden change? Blue Cross Blue Shield explicitly cites the implementation of the No Surprise Law as its rationale.

Similarly, UnitedHealthcare is trying to intimidate doctors into agreeing to a 40 percent cut or they will lose their contract. The American College of Emergency Physicians will retain legislators warning about this power tactic, because the insurance companies will continue to operate if they are not stopped.

It is important to understand how this tactic affects patients. Emergency departments, especially in smaller or rural communities, will be forced to make difficult decisions about how to allocate scarce resources to continue treating their patients. Options include reducing staff, changing work schedules and adjusting workloads so they can meet their legal obligation to stay open 24 hours a day, 7 days a week and see every patient that walks through the doors – no easy feat in the midst of a pandemic when they are already understaffed and facing severe professional burnout.

Emergency doctors have a hard time, especially those who have their own practice. Bad behavior by insurers, such as terminating contracts and refusing to pay for services, continues to strain many doctor-led groups that are already buckling under enormous pressure.

Helped by the regulatory language that guides NSA implementation, insurance companies choose policies that put emergency rooms at risk of closure. It’s heartbreaking, but more than that, it’s dangerous. It is impossible not to worry about the safety of thousands of people, especially in smaller towns or underserved areas where the nearest available emergency doctor is a few hours away.

In practical and immediate terms, the implementation of this law will reduce the ability of frontline professionals to treat patients during surges, whether caring for an influx of people with COVID, victims of mass casualty events such as shootings, or helping people with heart attacks or drug overdoses.

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Insurance companies argue that cuts to physician reimbursements will create an opportunity to make insurance coverage more affordable for everyone. However, year after year, insurers are making profits while the cost of employer-sponsored family health insurance is rising. According to Kaiser Family FoundationThe financial burden of franchises has increased by 92% over the last decade.

The cuts facing emergency rooms in North Carolina can be catastrophic at any time, but they do much more harm in the midst of a pandemic, when healthcare workers are already burnt out, overworked and facing increasing financial hardship.

Congress carefully crafted the No Surprises Act to create an impartial billing dispute resolution process. When the administration wrote the implementation rules, they fundamentally changed the compromise that all the participants had spent years agreeing on. These dangerous revisions cannot stand.

ACEP, American College of Radiology and American Society of Anesthesiologists take legal action undo the latest federal government changes. We will fight for the No Surprises Act to allow unexpected bills, as Congress intended, instead of allowing insurance companies to twist the law in their favor, leaving patients and doctors in the cold.