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TUCSON, Ariz., March 20, 2017 -- A number of states, including New York, Maryland, Texas, Colorado, New Jersey, Connecticut, and California, have passed laws to address the issue of surprise medical bills, and Congress is considering similar legislation. Purportedly intended to protect patients from excessive out-of-network charges, the main effect is to protect insurers’ efforts to dictate fees of physicians who decline to contract with them, writes New York neurologist Lawrence R. Huntoon, M.D., Ph.D., in the spring issue of the Journal of American Physicians and Surgeons.
Since many people expect everything to be covered by insurance, virtually any medical bill might be a surprise. Also many patients believe, erroneously, that all physicians working at a hospital are employees of the hospital, and the hospital bills for and controls the fees charged by its physician employees, Dr. Huntoon explains.
Laws that virtually force all physicians to be the equivalent of in-network help hospitals achieve their objective of controlling physicians in the interest of enhancing their own bottom line, writes Dr. Huntoon. With the effectively coerced cooperation of physicians, hospitals will implement strict cost-containment protocols to patients’ detriment.
Surprise billing laws will allow insurers to reduce fees paid to all physicians and achieve windfall profits. The only leverage in-network physicians now have with giant insurers is that if they do not like the terms of the insurance contract or if they believe fees are set too low, they can refuse to sign contracts with the insurer and become an out-of-network physician, Dr. Huntoon explains.
Laws like the one in California allow insurers to dictate physician fees and protect insurers from having to meet their obligation to pay market fees to non-contracted physicians. However, the government is also likely to severely restrict insurance premiums. The result is likely to be like the American single-payer system for the elderly—Medicare—in which insurers just process claims for government, which dictates payment and, increasingly, the care that can be offered.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
Contact: Lawrence R. Huntoon, M.D., Ph.D., [email protected], or Jane M. Orient, M.D., (520) 323-3110, [email protected]
