WASHINGTON – The Blue Cross Blue Shield Association (BCBSA) filed an amicus brief in the lawsuit challenging parts of the new surprise billing law, led by the Texas Medical Association. The lawsuit threatens to obstruct the implementation of parts of the patient-friendly No Surprises Act that went into effect on Jan. 1, 2022.
The law protects patients from unanticipated and costly surprise medical bills and requires health insurers and health care providers to work together to resolve these bills. This is a balanced approach that protects consumers and ensures health care clinicians are paid appropriately.
As leaders in the health care community for more than 80 years, BCBSA believes that “the interim final rule (IFR)… will help remedy distortions in the market for health care services and restrain costs for patients.” Specifically, the brief states that the IFR:
Provides a Fair Approach
“The IFR prioritizes a payment metric that reflects the reasonable value of health care services… The median contracted rates reflected in the QPA represent the best evidence of true ‘market’ prices for health care services, and thus, as ‘the statue contemplates,’ ‘typically the QPA will be a reasonable out-of-network rate’ … Congress understood that median contracted rates reflect reasonable market values.”
Restrains Rising Health Care Costs
“The QPA’s function in the IDR process will help restrain rising health care costs for patients while fairly compensating out-of-network providers… Relying on the QPA as a primary consideration in the IDR process helps to curb future market distortions by limiting inflated costs and thus restraining rising premiums, benefitting all patients.”
Incentivizes Providers to Be In-Network
“The IFR incentivizes health care providers to participate in payor networks… The IFR will likely incent broader networks, as Surprise Billers who previously refused to join a network because they could exact excessive out-of-network charges directly from their patients will now have more incentives to contract at reasonable network rates.”
Follows Congress’ Intent
“The IFR reflects the Departments’ diligent efforts to faithfully implement the intent of Congress when it sought to end so-called ‘surprise billing’ … In the Act, Congress carefully considered the interests of health care providers, payors, and above all, patients. It balanced those interests in designing an IDR process pegged to the QPA… The IFR implements Congress’s considered judgment that the QPA represents the presumptively reasonable value for health care services covered by the Act.”
For more information on the payment resolution process, visit bcbsprogresshealth.com.