October 01, 2021
Area(s) of Interest: Out of Network Billing
CMA issued the following statement in response to the Biden Administration's interim final rule implementing the No Surprises Act:
“The interim final surprise billing rule issued this week to implement the No Surprises Act is a grave disappointment to California physicians. It will allow the multi-billion insurance industry to continue to reduce their physician networks, hurting patients who need frontline physicians when an emergency strikes. Ironically, these guidelines will ultimately harm patients by further jeopardizing access to care and increasing health care costs through consolidation,” said Peter N. Bretan, Jr., M.D., CMA President.
The new rule ignores the law and Congressional intent to create a fair process to resolve disputes. CMA worked closely with Congress for more than two years to craft legislation that protects patients from surprise medical bills while providing an impartial dispute resolution process for insurers and physicians to resolve disputes. However, the Administration’s rule is a complete giveaway to the insurance industry. While the law requires all factors to be equally considered in arbitration, the Administration establishes a presumption that the median rate is the appropriate payment rate – regardless of other factors. As we know from our experience in California, such a rule will further disincentivize insurers from contracting with physicians in good faith which threatens patient access to in-network hospital-based physicians needed in emergencies, particularly physicians serving in underserved and rural safety net hospitals. Physician practices already stressed from the COVID-19 pandemic cannot maintain viability and will either be forced to close their doors or consolidate with larger systems, including private equity, which drives-up health care costs. A RAND study of California’s surprise billing law concluded that it exacerbated consolidation.
Dr. Bretan said, “In California, we know how bad regulations can tip the scales in favor of insurers at the expense of patients and physicians. These rules are opening the door to more of what we have already experienced in California. We urge the Biden Administration to bring the rule in line with the law and Congressional intent and to aggressively mandate that insurers have adequate networks of physicians to meet patients’ medical needs.”