ACEP and EDPMA wrote to federal agencies on Feb. 26, requesting immediate actions to address health plans altering patient cost-sharing amounts after an independent dispute resolution payment determination.
This pattern of insurer behavior is in direct violation of the No Surprises Act. ACEP and EDPMA are very concerned about the lack of enforcement or Department communications emphasizing the need for compliance with these patient protections.
“We have witnessed health plans engage in this practice as an apparent means to avoid amounts due to providers after the ruling of a certified IDR entity,” the letter states.
ACEP and EDPMA request immediate actions to:
- Ensure that patients are not subjected to health plans’ overt disregard of the No Surprises Act cost-sharing protections through “after the fact” changes to their cost-sharing liabilities;
- Protect providers from making inadvertent requests for patient payment based on faulty health plan information that is setting or changing patient cost-sharing liabilities in violation of the protections guaranteed by the No Surprises Act;
- Compel health plans to transfer to providers the correct out-of-network rate amounts due as explicitly laid out in the No Surprises Act;
- Responsibly administer the implementation of the No Surprises Act by taking enforcement action against health plans for this overt disregard of federal statute.
Related:
Insurer Abuses Called Out During Hearing on Flawed Surprise Billing Law Implementation
Four for Four: Courts Side with Physicians in String of Surprise Billing Legal Wins
