A survey of anesthesiologists shows that insurers are abruptly terminating physician contracts, forcing many of the specialists out of network.
Anesthesiologists are being forced out of network as private insurers terminate their physician contracts with little to no notice, according to a recent survey conducted by the American Society of Anesthesiologists (ASA).
In the survey, 42 percent of anesthesiologists reported having contracted terminated by insurers in the last six months. Additionally, 43 percent of the specialists saw “dramatic” reimbursement rate cuts from the insurers, both mid-contract and at renewal. In some cases, the rate cuts were as high as 60 percent and some of the contracts impacted by the cuts were signed less than six months prior.
ASA noted that the survey distributed in February was “informal” and “non-scientific,” soliciting responses from just 76 practices in 33 states. But the findings did confirm anecdotal claims that insurance companies, not specialists, are behind one of the nation’s most pressing healthcare problems: surprise medical billing.
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“This survey appears to confirm what we have been hearing from our members: that insurers may be forcing more physicians to be out of network to shore up their profits while negatively impacting patients,” stated ASA president Mary Dale Peterson, MD, MSHCA, FACHE, FASA. “ASA is committed to ending surprise medical bills and is extremely disappointing to hear that insurance companies may be taking advantage of current legislative efforts to hurt patients and physicians.”
Surprise medical billing is when a patient receives an unexpected and/or excessive medical bill for care they received at a hospital or doctor’s office. In many cases, the unexpected bill is sent by the provider because patients received care from a provider who is not in their health plan’s network even though the facility is.
Surprise medical billing from an out-of-network provider impacts one in five insured adults, according to data from Kaiser Family Foundation. These charges expose patients who are already facing increased financial responsibility for care to higher cost-sharing, researchers from the foundation stress.
Recent legislative proposals have thrown surprise medical billing into the spotlight, and with that providers and payers have been pointing fingers to ensure legislation designed to eliminate the problematic bills for patients targets the true driver of the bills.
Payers and providers have been sparring over surprise medical billing solutions, with payers favoring a benchmark rate for out-of-network provider services and providers advocating for an independent dispute resolution process.
But results from the ASA survey are supporting provider complaints that payers are terminating payer contracts abruptly, leading to surprise medical billing.
ASA stated that survey respondents represented a variety of groups, from 35-member physician groups to large national groups. The responses showed that United Healthcare Insurance Company was the most associated with terminating contracts and reducing reimbursement rates. Respondents also mentioned Aetna, Cigna, and Blue Cross Blue Shield.
“While the timing alone suggests insurance companies are motivated by factors related to anticipated legislative changes on surprise medical bills, some survey respondents reported they were specifically told by insurers this was the case,” the ASA stated in the survey.
It is this finding that supports ASA’s endorsement of a surprise medical billing solution that includes a market-based mechanism for determining reimbursement rates for anesthesiologists such as an independent dispute resolution process in which payers and providers can dispute out-of-network charges.
“Currently, a very small percentage – approximately 8 percent – of anesthesiologist claims, nationwide, are out of network, often for reasons outside the control of the physician,” added Peterson. “ASA will continue to closely monitor the activities of these insurance companies to track how their actions will exacerbate the public’s exposure to surprise medical bills. Clearly, giving more power to the insurance companies is not the answer.”