Balanced Billing Laws – A Glimpse into the No Surprises Act’s Shortcomings

Stethoscope on medical billing statement on table

While the No Surprises Act is, in itself, a balanced billing law, many states banned balanced billing before the introduction of the NSA. These articles provide a glimpse into predictions of the Act’s shortcomings from 2019, including a decrease in reimbursements to providers and access to patient care.

The California Surprise Billing Law has aggravated numerous physicians. The U.S. Congress looked at California as a model for developing national law against surprise or balanced billing. 

Although patients are being insured and protected, insurance companies have the upper hand in their negotiations with doctors, which can negatively impact patients themselves – leading anesthesiologists like Antonio Hernandez Conte to see an overall decrease in access to patient care.

Based on a California Medical Association (CMA) survey of 855 physician practices, 90% revealed that the law allowed insurers to decrease physician networks, which ultimately limited patients’ access to in-network doctors.

The California balanced billing law also resulted in fewer insurers negotiating payments and reducing doctors’ bargaining power and ability. After examining more than 17 million specialty claims by affected California physicians, results revealed that specialty physicians services delivered out-of-network at hospitals declined by 17% after the law took effect.

California’s balanced billing law led to a drop in physicians’ motivation for providing out-of-network care since their reimbursements fell. Now that the NSA is expanding the same payor-provider dynamics, we are likely to see history repeat itself on a national level.

The CMA provided a reasonable suggestion when they expressed the need to establish an approach that is more balanced and beneficial to all parties involved back in 2019. The CMA proposed that Congress should consider adopting a law that is similar to the law in New York, which has been in effect since 2015 and has evidently demonstrated success when considering balanced billing.

Providing unilateral control of the market to insurers is not only harmful in many ways, but also dangerous to the overall healthcare industry.

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