No Surprises Act

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Not a good bill. Well, great for insurers. Requires out-of-network providers to not bill any difference between in-network and out-of-network. So an insurer can buy an emergency group, contract with that group at 10% what they pay everyone else, cancel all other contracts, and guess what? You're now getting what they pay their own group. Think it's not possible? I know for a fact that one SDG was approached by a major insurer to purchase their group.
 
southerndoc said:
Not a good bill. Well, great for insurers. Requires out-of-network providers to not bill any difference between in-network and out-of-network. So an insurer can buy an emergency group, contract with that group at 10% what they pay everyone else, cancel all other contracts, and guess what? You're now getting what they pay their own group. Think it's not possible? I know for a fact that one SDG was approached by a major insurer to purchase their group.
Click to expand...
Yeah most of info I could find on that specific bill was from last year. I saw a synopsis on Lamar Alexander’s website and it seemed he was in favor of it which is why I ended up posting.

His website implied it was similar to the NY law but I couldn’t find other comparisons.
 
maxxor said:
Yeah most of info I could find on that specific bill was from last year. I saw a synopsis on Lamar Alexander’s website and it seemed he was in favor of it which is why I ended up posting.

His website implied it was similar to the NY law but I couldn’t find other comparisons.
Click to expand...
Lamar is leaving the Senate and headed for a cushy spot on the BCBS BOD most likely. He’s trying to deliver a win for them on the way out.
 
southerndoc said:
Not a good bill. Well, great for insurers. Requires out-of-network providers to not bill any difference between in-network and out-of-network. So an insurer can buy an emergency group, contract with that group at 10% what they pay everyone else, cancel all other contracts, and guess what? You're now getting what they pay their own group. Think it's not possible? I know for a fact that one SDG was approached by a major insurer to purchase their group.
Click to expand...
I was under the impression that this was the old proposal. I thought I had read that the new proposal was to get a mediator if the parties couldn't agree on a price. It is very possible that I may be misinformed, though.
 
maxxor said:
www.radiologybusiness.com

UnitedHealthcare knocks Envision radiologists out of its network over ‘egregiously high rates’

All told, the private equity-backed physician services firm employs more than 900 radiologists operating in 570-plus facilities.
www.radiologybusiness.com www.radiologybusiness.com

The first insurer to take advantage of the balance billing law?
Click to expand...

More than likely. They've been targeting Envision for a while, and probably use this as justification.

Georgia recently selected FAIR Health Database for its balance billing law. I'm glad to see that because it's fair (no pun intended) and doesn't rely on insurers self-reporting what they pay, which was shown to be dishonest with previous laws. They were caught red-handed lowering the amount they paid providers to lessen the median rate.

The federal law allows state laws to supercede if they offer minimum patient protections, which luckily Georgia does. However, states cannot regulate ERISA plans and the federal law will prevail on ERISA plans.

Let's report the real elephant in the room:

For the year ending 12/31/2019, UnitedHealthcare CEO total compensation was $52.1 MILLION. Their reported $1.3 million salary is padded by $4.5 million in nonequity incentive pay, $27 million in exercised stock options, $18 million on value realized on vesting shares, and $200k in "other compensation."
 
KKR's fund fees pay for CEO salaries, they don't take any distributions from portfolio companies, only earning money when they exit or recap and see a gain.

The idea that anyone in this story, Envision or United Health, really cares about doctors or patients is laughable.
 
How do we get some equivalent of the Stark law passed for insurers given that their next frontier is to buy and run their own health networks?

Yeah I know the insurers lobby well, but if you're going to be a for-profit insurer then you're #1 priority is, by far, enriching your shareholders. BCBS, United etc have a fiduciary duty to their shareholders, not their covered lives.

It doesn't take a rocket scientist to suspect that for-profit insurer-owned clinics/hospitals etc would do everything they can to not spend $ on providing care in an effort to simply further enrich themselves, probably to the detriment of patient care. It's the mirror image of the supposed rationale underpinning Stark.

So do the hospitals, docs, and nurses unite against the insurers to get something like this through? Or do enough docs, nurses, and patients go to the press to raise an alarm? Something else?
 
namethatsmell said:
How do we get some equivalent of the Stark law passed for insurers given that their next frontier is to buy and run their own health networks?

Yeah I know the insurers lobby well, but if you're going to be a for-profit insurer then you're #1 priority is, by far, enriching your shareholders. BCBS, United etc have a fiduciary duty to their shareholders, not their covered lives.

It doesn't take a rocket scientist to suspect that for-profit insurer-owned clinics/hospitals etc would do everything they can to not spend $ on providing care in an effort to simply further enrich themselves, probably to the detriment of patient care. It's the mirror image of the supposed rationale underpinning Stark.

So do the hospitals, docs, and nurses unite against the insurers to get something like this through? Or do enough docs, nurses, and patients go to the press to raise an alarm? Something else?
Click to expand...
There will be no doctor friendly legislation for some time I fear.
 
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