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The American Society of Anesthesiologists (ASA) is disappointed that the Surprise Billing Final Rule fails to protect patient access to their chosen providers and enables insurers to inflate profits at patient and provider expense.
The independent dispute resolution (IDR) process outlined in the final rule still does not match the statutory description in the No Surprises Act. The rule skews the IDR process to favor the insurer-calculated Qualifying Payment Amount (QPA) over other factors Congress specifically directed IDR arbitrators to consider equally with the QPA.
This flawed approach will further embolden profit-driven insurance companies to drive community physician practices out of network if not out of business. Blue Cross Blue Shield of North Carolina and Blue Cross Blue Shield of Tennessee have cited the new law when demanding providers accept drastic reimbursement cuts for services provided or risk contract termination.
Many providers — already reeling from the economic impact of COVID-19 — can’t withstand this added blow and may be dropped from network. Such network reductions strip patients of access to their chosen providers, reduce access to care, and may delay diagnosis and treatment of illness and injury.
Insurer profit increases do not lower beneficiary costs. Insurance premiums continue to rise with insurance company revenue. Insurers’ net incomes and profit margins have grown every year since 2015, including record profits in 2020, even as their costs dropped.
ASA is evaluating this final rule in the context of our pending litigation and exploring regulatory and legislative opportunities to achieve the balance Congress intended, safeguard adequate provider networks, and protect access to care by ensuring sensible, sustainable reimbursement.
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