Maurice Langston: More Health Insurance Surprises on the Way?

About a week ago, one of the country’s largest health insurance companies sent a signal flare that should catch the attention of every doctor, patient and lawmaker in America.

United Healthcare plans to cancel its contract with Mednax for medical services to patients in Georgia, South Carolina and North Carolina who have United Healthcare insurance. Is Florida next? Mednax is a company that staffs physicians at hospitals and healthcare centers.

As United Healthcare makes this unilateral decision to game the system for financial gain, Congress is preparing to give them even more power if insurers get their way.

Congress is still considering solutions to the problem of surprise medical bills and a proposal known as “rate setting” just won’t go away. This misguided approach would give insurers the rubber stamp and economic incentive to pay doctors and hospitals below-market rates for providing critical and life-saving care, meaning that medical professionals would be absorbing the true costs of treating patients.

This is an unsustainable model which would be a death warrant for many emergency room physicians, medical specialists and rural community hospitals which are often the only available treatment centers for many Americans.

Insurance companies are leaning hard on Congress to pass rate setting into law. The longer Congress leaves the door open for a legislative prescription that gives insurance companies the ability to game the system for financial gain, the more surprise terminations we will see.

These surprise terminations come as doctors are attempting to negotiate a fair payment. In the case of Mednax, United demanded a 50 percent cut before leaving the table and terminating their contracts. A survey from the American Society of Anesthesiologists found that 60 percent of respondents had a contract terminated in the last six months, with four out of five of those respondents reporting that United was the insurer who was responsible. Surprise terminations create real confusion for patients, who might find out at their next doctor visit that they are no longer covered in-network by their insurance plan

If rate setting becomes law, United’s decision to sever ties with Mednax will only be the tip of the iceberg. Insurance companies will quickly engage in mass contract cancellations and heavy-handed, unilateral “renegotiations” with providers that will have no choice but to accept a potentially devastating reimbursement cut in-network or go out-of-network to receive the same rate.

Patients are the biggest losers under rate setting. They face more out-of-pocket expenses thanks to shrinking insurance networks and serious problems accessing care due to doctor shortages and hospital closures. California has a similar law on the books and has already seen the effects. In a survey of California doctors, 88 percent said the law allowed insurers to shrink physician networks, decreasing patient access to in-network physicians.

Congress should heed this warning and make sure rate setting, in any form, is excluded from any legislative solution to surprise medical bills. Instead, lawmakers should look to a proven, fair solution known as independent dispute resolution (IDR). This system has delivered results in New York, where it has drastically reduced consumer complaints about surprise medical bills, saved $400 million for patients, and held insurance premiums steady. IDR shields patients from billing disputes by taking them out of the middle and requiring they only pay their in-network commitments. Providers and insurers then reach a fair, equitable reimbursement in arbitration. Other states, including Texas, have adopted similar solutions.

Congress has multiple IDR proposals on the table, including one by U.S. Sen. Bill Cassidy, R-La., a doctor who has dealt with insurer tactics firsthand. These proposals are gaining real momentum with 29 bipartisan cosponsors in the U.S. Senate and more than 100 in the U.S. House of Representatives. Unsurprisingly, insurers are trying to water down any bill that includes IDR in order to achieve backdoor rate setting that weakens patient protections. If Congress stands strong and passes a meaningful IDR law, patients will finally be rid of surprise medical bills once and for all.

United isn’t shy about its plans to push patients out of network in order to boost their own bottom line, and other insurers are lined up right behind them. Congress should listen to what the insurers are saying – and then make sure to head them off with a surprise billing solution that protects patients, not insurance companies.

 

Maurice Langston is the chairman of the Florida Council for Safe Communities.

 

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