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  A SECOND OPINION ON SURPRISE MEDICAL BILLS

  Posted by name on April 17, 2024 at 12:33 pm

  A SECOND OPINION ON SURPRISE MEDICAL BILLS — Lawmakers thought they solved the issue of surprise medical bills nearly four years ago, but new federal data shows the solution might need a second look, Robert reports.

  Early data shows that private equity firms disproportionately benefit from the No Surprises Act, and insurers are flouting its rules. Now, some experts warn that a law meant to save money could increase costs for consumers.

  “It’s not working the way we want it to work,” said Rep. Brett Guthrie (R-Ky.), head of the House Energy and Commerce Health Subcommittee. Guthrie said he recently met with CMS to discuss the law’s implementation.

  “We have to figure out what it’s going to take to get it to work,” he added.

  The law aims to shield patients from a surprise bill if they inadvertently get care outside of their insurance network. It set up an arbitration system where payers and health providers can settle disputes.

  But early data released by CMS in February shows private equity-backed groups initiate most disputes — and often win them.

  An analysis from the Brookings Institution explored disputes across three categories: imaging, neonatal/pediatric critical care and emergency care. The analysis found that four private equity-backed firms generated 74 percent of the disputes.

  A major reason smaller groups don’t participate more often is the wait time, experts said. It can take months to wind through the arbitration process because of a system backlog.

  HHS initially estimated that only 17,000 claims a year would reach arbitration. From April 2022 through June 2023, there were nearly 490,000 disputes, according to a report from the GAO.

  HHS told Robert in a statement that it has brought more third-party arbiters online, and more disputes are being processed. CMS proposed a rule in October requiring insurers to divulge additional information to speed up the process.

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