A screenshot from the Coalition Against Surprise Medical Billing's new television ad. Credit CASMB
Health insurers, employer groups and a labor union are teaming up to attack the current version of the No Surprises Act independent dispute resolution system on television.
The Coalition Against Surprise Medical Billing — an organization that represents the IDR system's critics — is spending more than $1 million to run television ads depicting the health plans involved in a health claim payment dispute as well-meaning chickens, the lawyers representing the health care providers as foxes, and the judge presiding over the case as a fox.
A narrator says the current IDR approach is "like putting the fox in charge of the henhouse," and the ad ends with the statement, "Fix the No Surprises Act."
The coalition includes America's Health Insurance Plans, which is a group for health insurers, and the ERISA Industry Committee, a group for employers with self-insured health plans.
The coalition also includes the National Association of Benefits and Insurance Professionals, the Purchaser Business Group on Health, the National Business Group on Health, the National Alliance of Healthcare Purchaser Coalitions, and groups such as the National Federation of Independent Business and the National Retail Federation.
Another coalition supporter is UNITE HERE, a union that represents about 300,000 workers in the hospitality, gaming, food service and garment industries.
What it means: Influential insurer and employer groups in Washington think they can put No Surprises Act IDR system change on policymakers' to-do list.
The backdrop: Benefits advisors worked for decades to persuade Congress to protect insured patients who try to follow plan rules against big, unexpected bills from providers who turn out to be outside the plan networks.
The federal No Surprises Act is supposed to eliminate some surprise bills, by requiring a provider and a plan to resolve a billing dispute between themselves, without involving the patient, in two scenarios.
One type of covered situation occurs when a patient receives covered emergency care from an out-of-network provider.
The second type of covered situation occurs when a patient accidentally sees an out-of-network provider while using an in-network hospital.
The providers and plans are supposed to send the disputes covered by the No Surprises Act rules to a special independent dispute resolution system.
Insurers and plan administrators say the IDR system has performed poorly.
The critics contend that most of the IDR system cases are filed by big health care companies backed by private equity firms, not by ordinary health care providers.
Some private-equity-backed providers are flooding the IDR system with claims that are clearly not eligible to use the system, the critics say.
The IDR systems almost always side with the providers, and they are awarding provider reimbursement amounts that are far higher than what in-network providers typically get, the critics argue.
Providers, in turn, say insurers and plans are angry about the IDR services agreeing with the providers that the payers ought to pay providers more.
Actually getting payers to pay the amounts awarded by the IDR services is difficult, according to the providers.
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