Hospital (Photo: Thinkstock) (Photo: Thinkstock)

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.

Section 308 of S. 1895

Section 308 of the “Lower Health Care Costs Act” bill would require producers to provide regular, detailed compensation reports to employer plan sponsors.

In the individual market, individual coverage providers would be responsible for sending producer compensation reports to the coverage holders.

S. 1895 was introduced by Sen. Lamar Alexander, R-Tenn. the chairman of the Senate HELP Committee, and by Sen. Patty Murray, D-Wash., the highest ranking Democrat on the committee. Most of the bill consists of price disclosure provisions and other provisions that would affect doctors, hospitals, drug makers and emergency transportation providers.

Members of the full Senate Health, Education, Labor and Pensions Committee are preparing to vote on S. 1895 at a meeting set to start at 10:30 a.m. Eastern Daylight Time Wednesday.

Insurance Community Group Reactions

The officers of the National Association of Insurance Commissioners (NAIC) and Matt Eyles, the president of America’s Health Insurance Plans (AHIP), have responded to S. 1895 with comment letters praising the effort to control surprise medical bills.

Neither the NAIC comment letter nor the AHIP letter directly mentions Section 308.

Resources

A copy of S. 1895 is available here.

A copy of the AHIP comment letter is available here.

A copy of  the NAIC comment letter is available here.

A copy of the AHA comment letter is available here.

— Read Key Health Bill Draft Includes Agent Comp Disclosure Sectionon ThinkAdvisor.

— Connect with ThinkAdvisor Life/Health on FacebookLinkedIn and Twitter.