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June 24, 2019 at 01:50 PM
Health insurance agents and brokers may get direct, or indirect, help from emergency room doctors and hospitals in stopping a major, popular Senate health insurance producer compensation proposal.
(Related: Senators Avoid Agent Comp Topic at Health Cost Bill Hearing)
The American College of Emergency Physicians (ACEP) is one of the most visible groups trying to fight the bill containing the provision, S. 1895.
Hospitals also have an incentive to oppose the bill.
Emergency Room Doctors
Some of the provisions in the “Lower Health Care Costs Act” bill are efforts to protect insured patients against “surprise medical bills,” or bills that result either from use out-of-network emergency care, or from use of services at in-network facilities that turn out to employ out-of-network subcontractors.
Dr. Vidor Friedman, president of ACEP, has put out a statement saying ACEP agrees with the goal of protecting patients from surprise bills.
“However, emergency physicians strongly oppose the bill’s “benchmarking” approach and remain very concerned that, as written, the legislation strongly favors insurance companies while creating new barriers that would limit patient access to emergency care,” Friedman says.
The real cause of surprise medical bills is health insurers’ increasingly narrow provider networks, and non-transparent provider reimbursement structures, and S. 1895 would give insurers incentives to cut their rates and narrow their networks even more, Friedman says.
Hospitals
Small hospitals, their owners and their trade groups could also mobilize against S. 1895.
Thomas Nickels, executive vice president of the American Hospital Association (AHA), has submitted a comment letter supporting the goals of the bill but opposing the surprise billing provisions.
Jessica Gladstone and other analysts at Moody’s Investors Service concluded in a report last week that surprise medical bill provisions in S. 1895 or similar legislation could hurt hospital staffing companies, and hospitals that treat a high percentage of patients on an out-of-network basis.
Big hospitals are more likely to be part of an insurer’s provider network, and that means that any surprise bill provisions are more likely to affect smaller hospitals, the analysts said.
One particular approach, requiring hospitals to guarantee patients in-network prices for care, would be especially hard on hospitals that hire outside companies to handle all emergency room operations, the Moody’s analysts predicted.
