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The unveiling of a new federal rule last week to prevent “surprise” medical bills is worth covering on its own merit. The expected lobbying battle about this rule also could provide a good news peg for digging into one of the key debates about what’s causing the cost of health care to continue its rise in the U.S.
At the heart of recent battles over surprise bills is the question of how much insurers should pay for out-of-network medical care.
The Biden administration’s rule leans toward using payment rates already established within insurers’ networks in resolving disputes about out-of-network care. Known as the qualifying payment amount (QPA), this benchmark is pegged to the median contracted rate. Other factors may be considered in resolving payment disputes, but QPA is described as something akin to a stand-in for an “appropriate” out-of-network rate in the rule. Continue reading
ValuePenguin and LendingTree.Largest U.S. Health Insurers of 2021 by 2020 revenue. (Click to enlarge.)
On July 1, the nation’s largest health insurer, UnitedHealthcare (UHC), stopped paying out-of-network claims when its fully insured members seek non-emergency care outside of their local coverage areas, according to Nona Tepper’s reporting in Modern Healthcare.
UHC’s decision to end some out-of-network coverage caught hospitals, physicians and other providers by surprise, she wrote, adding that the move could be aimed at controlling costs and reducing payment to providers.
If providers are surprised, so too could be many of UHC’s 49 million members, particularly those who need to get care outside of their coverage areas, such as those who live in rural counties and those who need treatment for substance abuse, Tepper wrote. Continue reading
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Over the past several years, health care journalists have done great work highlighting the problem of surprise medical bills. There’s been so much coverage that even the U.S. House of Representatives has begun examining the issue, as Vox’s Sarah Kliff reported on March 25.
Among the many surprise patient medical bills that Kliff and others have reported about come from air ambulance companies. Continue reading