The American Association of Anesthesiologists accused North Carolina’s Blue Cross Blue Shield of using the impending ban on unexpected charges as a reason for clinicians in the “Strong Arm” network to lower their rates.

The non-profit payment agency with 3.8 million members wrote to 54 anesthesiologists, radiology departments, emergency departments and other clinicians earlier this month threatening to cancel their contracts unless they agreed to reduce payments by up to 30%. The payer stated in the letter that the decrease in payment was due to the No Surprises Act, which will take effect in early 2022.

HHS has developed an accidental billing resolution process in the new rules

As the legal deadline approaches, vendors are scrambling to draw attention to independent dispute resolution procedures that determine fair market rates, which they say gives insurance companies too much influence. In October, CMS instructed the arbitrator to determine the appropriate out-of-network rate based on the median contract rate of the insurance company for the same service in a certain geographic area. The Congressional Budget Office estimates that the shift to market-driven prices will reduce insurance premiums by up to 1%.

“I don’t think that when someone overcharges, it must now cause harm to the overcharger [accept] A fair price,” Xavier Becerra, Minister of Health and Human Services, told Caesars Health News. “Those who overcharge either have to tighten their belts and do better, or they cannot continue to operate. “

HHS has indicated that it will review comments on the rule, and approximately 150 members of Congress have claimed that the rule violates Congress’s intentions and should be modified.

Becerra says unexpected billing rules force overcharged doctors to accept fair prices

“By definition, if they exist for a long time, they must always work for both sides,” said Dr. Randall Clark, president of ASA. “If health plans require objective measures to maintain adequate networks, they will need to negotiate in good faith with doctors.” Providers like ASA say that giving insurance companies the upper hand will allow them to lower their payout rates and force doctors to withdraw from the network. And business interruptions, reducing the patient’s ability to get the care they need. The professional association representing 54,600 anesthesia providers across the country believes that long-term contracts should be maintained between payers and providers, and state and federal regulatory agencies should establish network adequacy standards for insurance companies.

He said that the ASA does not support a group of providers who use out-of-network as a business strategy.

A spokesperson said that BCBS North Carolina stated that it has sent these letters to the state’s most expensive medical institutions, which charge members of insurance companies 500% more than they charge Medicare patients. . The insurance company said these practices represent only a small fraction of the thousands of contracts it can negotiate to obtain more reasonable rates.

Download Modern Healthcare’s app to keep up to date when industry news breaks out.

“Blue Cross NC is very pleased that Congress has taken measures to protect patients from unfair and expensive medical expenses. We are very pleased to have the opportunity to leave patients out of the middle and negotiate directly with the most expensive for-profit providers,” the spokesperson said. “We are committed to doing everything we can to make health care more affordable for our members, and to make health care services more accessible to more people in North Carolina.”

Studies have shown that patients will encounter a large number of unexpected bills in the anesthesiology department, partly because they usually cannot choose an anesthesiologist. According to a study by Yale University, in 2015, 12% of in-network hospital bills included unexpected expenses for anesthesia services. Studies have found that the service fees charged by these providers are more than eight times the medical insurance rate.

“Medical insurance is an arbitrary system established by CMS. It is not affected by negotiations and has nothing to do with the cost of providing anesthesiology services,” said Clark of ASA. “If North Carolina’s Blue Cross Blue Shield or others interpret their new powers as an opportunity to increase health insurance rates, there will be severe disruptions and massive loss of services in many places where they are really needed.”