The country’s largest payer lobbying group claims the No Surprises Act is not narrowing physician networks, contradicting reports from radiologists and other physicians.
AHIP and the Blue Cross Blue Shield Association recently polled 21 U.S. health insurance providers about their experiences with the landmark legislation. Respondents estimated that the NSA prevented more than 10 million surprise medical bills from reaching patients in the first nine months of 2023.
About 67% of payers said they had increased provider networks since surprise-billing legislation took effect in 2022 and 33% left them untouched. Zero said they had reduced doc networks, the groups reported Monday.
“I'm proud to see that the No Surprises Act is doing what it’s supposed to—protecting millions of families from unexpected financial hits…,” David Merritt, senior VP of policy and advocacy for BCBSA, said in a Jan. 29 announcement.
“A lot of this (like the provider networks) does not align with what we’ve been hearing from providers,” Jeffrey Davis, health policy director for McDermott+Consulting, wrote on social media Monday in response to the survey.
The American College of Radiology and its Neiman Health Policy Institute recently issued two analyses on the NSA. In one, experts noted that radiologists were already nearly 99% in-network before the law took effect.
“However, insurers are using the nontransparent, payer-calculated ‘qualifying payment amount’ to artificially drive down payment and narrow coverage networks,” Joshua J. Cooper, VP of government relations and economics health policy for the American College of Radiology, said in a statement Tuesday. “Blue Cross Blue Shield of North Carolina, BCBS of Tennessee and Cigna of Tennessee have cited the NSA in demanding providers accept drastic payment cuts or risk contract termination. Many sites that cannot absorb such cuts are dropped from network. These network restrictions ultimately impact all care.”
AHIP (formerly America's Health Insurance Plans) estimated that nearly 80% of NSA-eligible claims have been resolved without using the independent dispute resolution process. But their research highlighted a “growing and troubling trend—the skyrocketing use of IDR.” Federal agencies originally estimated that 17,000 claims would go through arbitration each year. Instead, nearly 335,000 were submitted between April 2022 and March 2023, almost 14 times greater than anticipated.
“This increase in the use of the IDR process suggests that certain providers and hospitals may be attempting to exploit the arbitration process solely to increase profits,” AHIP and BCBSA said.
In another recent Neiman analysis, researchers found that radiologists rarely break even in these payment disputes, with high costs limiting providers’ ability to use arbitration. Recovered payments do not even cover IDR fees in about 57% to 74% of instances.
“The fact that providers stand to lose more than they can gain by entering the IDR process precludes many providers—including radiologists—from entering the IDR process and, thus, reimbursement may drop to levels below what is needed to support patient access to care in their communities,” ACR’s Cooper said in the statement. “Given that the IDR process is not a financially viable option for providers if awarded only the qualifying payment amount, IDR decisions, including payment amounts, should be made available to researchers to assess unintended consequences of the legislation.”
“The AHIP study shows again that for most radiology groups the financial threshold for going through the IDR process has little return on investment,” Bob Still, executive director of the Radiology Business Management Association, said by email. “The claims are relatively small dollars with complicated IDR processes to manage.”
Read previous coverage of the NSA at the links below. You can find the full report from AHIP and the Blue Cross Blue Shield Association here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.