Credit: Shutterstock
Federal regulators should stop health care providers from using the No Surprises Act arbitration system to weaken health plan provider networks, employer groups told Trump administration officials.
"Employers cannot continue to absorb the financial burden of a broken process that rewards gaming over fairness," the benefits groups wrote in a public letter.
The No Surprises Act "independent dispute resolution" is supposed to protect many patients with health coverage against the risk of getting big bills for out-of-network care. The act applies to patients getting emergency care and, in many cases, to insured patients who end up getting care delivered by out-of-network doctors at in-network hospitals.
Some provider groups are inflating their IDR system charges, the benefits groups said.
Provider groups are also submitting claims for services that are not eligible for the IDR process, the benefits groups said.
The benefits groups cited Centers for Medicare and Medicaid Services data showing that 47% of the 610,000 arbitration cases filed in the first half of this year came from four private equity-backed organizations: Team Health, SCP Health, Radiology Partners and Envision.
Providers say the system finally gives them a chance to negotiate with the payers on an equal footing.
But the benefits groups say the strategy could make the current U.S. health care cost crisis worse.
"The IDR process should not be exploited as a default pricing mechanism," the benefits groups said. "Guardrails must be implemented to prevent abuse."
Regulators should punish providers who repeatedly send the No Surprises Act arbitration system claims that are not eligible for the system, the groups said.
Regulators should also require the arbitrators to explain decisions to award providers amounts that are far above the median in-network reimbursement level, the groups said.
The coalition that sent the letter included the American Benefits Council, the Business Group on Health, the CHRO Association, the ERISA Industry Committee, the Purchaser Business Group on Health, the National Alliance of Healthcare Purchaser Coalitions, the Silicon Valley Employers Forum and the Small Business Majority.
The officials who received the letter are Treasury Secretary Scott Bessent; Labor Secretary Lori Chavez-Deremer; Robert F. Kennedy Jr., the Health and Human Services secretary; and the deputies who handle health benefits issues — Derek Theurer and Kenneth Kies at Treasury, Daniel Aronowitz at Labor and Dr. Mehmet Oz the HHS.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.