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Doctors fighting a reimbursement battle with one of the biggest U.S. health insurers want to make sure that ending surprise medical bills doesn't come at the expense of their pay.
Anthem Inc. cut payments to some California physicians last month as part of what it called a routine adjustment to fees. Physicians say the move was the result of a 2016 state law that keeps patients from being forced to pay the difference when insurance companies and care providers clash over health costs.
California is one of several states that have acted to halt so-called surprise medical bills, an effort that is gaining traction on the national level. It limits how much doctors can collect when they don't have a contract with a patient's insurance plan, setting a benchmark payment rate for ending billing disputes.
Anthem, which runs Blue Cross Blue Shield health plans in 14 states, said its reimbursement changes were unrelated to California's law and that it increased pay for some clinicians.
Putting a stop to surprise bills has become a priority for the Trump administration. The House Committee on Energy and Commerce will consider legislation that mirrors California's approach in a hearing beginning on Wednesday. Doctors are lobbying lawmakers not to use California's overhaul as a template, saying they'd bear the brunt of such a change.
Large unexpected medical bills generally result from cases where patients get care outside their insurer's network, often in emergencies. Anthem's reimbursement cuts in California focus on physicians who work primarily in hospital settings, including pathologists, radiologists and anesthesiologists, doctors said. Anthem disputes that the anesthesiologists were affected.
"Insurers are terminating long-standing contracts with physicians or mandating significant rate cuts," the California Medical Association wrote in a July 10 letter to U.S. lawmakers. Cuts to hospital-based physicians could threaten patients' access to care, the group wrote.
Anthem's goal is to "promote equitable reimbursement for providers and support an adequate number of providers in our network while also addressing the need for our consumers to have access to quality, affordable health care," spokeswoman Joyzelle Davis said in an email.
Market Forces
Medical providers can set their list prices as high as they like, and physicians who primarily practice in hospitals have some of the highest. For example, before discounts negotiated with health plans, anesthesiologists charge almost six times the rate paid by Medicare for their services, according to a 2017 analysis in JAMA.
Doctors opposed to making California's benchmark-rate policies a nationwide blueprint worry that they doing so wouldweaken their bargaining power and force them to shoulder a disproportionate share of the burden for reducing health costs.
Bob Achermann, a lobbyist who represents California pathologists, said those specialists were seeing Anthem's rates for some services cut by 50%. He said the reductions could push some doctors to leave the insurer's network.
