Meanwhile the “insurance companies” (who should just change their names to plan administrators) are robbing employers, churches, and State, local, and Federal government plans blind. Premiums aren’t rising due to independent physicians or the NSA. They are rising due to astronomical prices negotiated with vertically integrated mega systems.
The lie they tell- “this out of network provider is so expensive!!! They are the problem!”
Their lie of ommission- they refuse to negotiate in network rates with these providers and force them to stay out of network with abysmal low rates- that if accepted would drive them out of business and into the waiting arms of the mega system- where they can easily raise costs.
The truth- they are paying big systems MASSIVE amounts while In-Network. (Example I heard recently- $130,000 in network for an endometrial ablation! ) But hey it’s in Network.
Reality check for employers- the “Networks” are worthless and don’t actually save you money. You are paying more than you would with an independent OON provider. Oh- and you might want to audit your plan administrator because they aren’t paying what they are telling you they are paying.
#insurancefail
The No Surprises Act created an entire new industry and costly bureaucracy for medical claims that should have been paid. The arbitration process costs doctors and groups sometimes more than the claim and you must pay the fee with no guarantee you’ll be paid a penny. Alas this article states, in some instances only 2% of the submitted claims are paid, but the arbitrators are paid regardless. Those listing single “large” payments as the rule, rather than the exception is disingenuous. One single “large” payment may still not even cover all the unpaid claims submitted. now insurance companies are in many cases, ignoring the decision by the arbitrator and not paying the claims. The fifth circuit court of appeals has now prevented physicians from suing to collect these amounts due to them, often siding “standing”.