More On Overturning the No Surprises Act
Surprise Medical Bills

More On Overturning the No Surprises Act

12/23/2024

It you haven’t yet read it, see my December 16, 2024, post, Now’s The Time to Overturn the No Surprises Act, for part 1 of this thread.

When that post was published on LinkedIn, my friend James Prudden commented, asking me how patients would be protected if the No Surprises Act were repealed.

Here’s my response to James.

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First, I don’t mean to be flippant, but the concept of “protection” has grown from receiving the benefit of a contract to not having to pay at all, and that’s, well, theft.

The short answer is by making the payor pay.

The long answer is:

The crisis was created when politicians did two things: exempted classes of patients from the obligation to pay (almost) anything because they have “coverage”, and took the pressure off of payors to come to contractual terms with physicians. In essence, they balanced the books, both politically and financially, by extracting the wedge from physicians. [And, if we want to be complete, my client hospital-based groups then shift as much of the burden to hospitals through stipend negotiations. Payors laugh all the way to the bank.]

Undoing all “no balance billing” statutes/regs would restore market forces. Payment would return to how it worked before the intervention that caused the crisis: the onus would be on the payors to either come to contractual terms with a physician/medical group, or to pay the out-of-network physicians’ charges (with some room to argue over usual and customary), with the caveat that the patient is responsible for co-pays and deductibles.

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What do you think?

Please add your thoughts as comments to the post.



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