“It feels like the 10 meetings that ACEP had with CMS to address the deficiencies with these interim regulations never happened, and that the numerous letters from ACEP, the AMA, state medical societies, EDPMA, the AHA, and others were never given the slightest bit of credence,” ACEP wrote in a letter to CMS dated December 2015.
Explore This IssueACEP Now: Vol 35 – No 05 – May 2016
Additionally, CMS noted that it will “consider ways to prevent providers from balance billing” despite the PPACA being very clear that balance billing is a permitted practice.
The December 2015 letter to CMS cautioned, “By adding language promoting a prohibition against balance billing for these claims in the face of a set of benefit standards that effectively permit plans to pay whatever benefits they choose, you have exceeded the authority provided by Congress in the PPACA, which recognized the right of out-of-network providers to receive the reasonable value of their services through, if necessary, balance billing.”
The letter, which has yet to garner a response from CMS, was the last straw prior to ACEP’s decision to take the matter to federal court.
“In light of the EMTALA obligation to provide emergency care regardless of payment, these Final Regulations, by allowing plans to unilaterally determine the reasonable value of these services, encourage an unconstitutional taking of physician and hospital services,” the letter stated. “In the plainest language we can use: these proposed Final Regulations pander to the profit motives of health plans, and they are biased and ill advised. In the strongest terms possible, we recommend that you reconsider this language in the Final Regulations, published or not, before you do irreparable damage to the emergency care safety net on which more than 130 million citizens a year, and health plans, for that matter, rely.”
CMS Rule Affecting Care
Dr. Kaplan said the CMS rule also affects emergency physicians’ ability to access other specialists as it fosters the creation of narrow networks of medical providers, making it more likely that patients will seek care out of network and receive additional bills from medical providers.
In a poll set to be released by ACEP in May, emergency physicians overwhelmingly said health insurance companies are misleading patients by offering “affordable” premiums for policies that actually cover very little.
Eight in 10 emergency physicians said they are seeing patients with health insurance who have sacrificed or delayed medical care because of high out-of-pocket costs, co-insurance, or high deductibles. This is more than a 10 percent increase over six months ago when emergency physicians were asked the same question.