In traditional Medicare, you and your treating physicians decide the care you need. In a Medicare Advantage plan and with corporate health insurance writ large, for-profit companies control whether you get the health care you need and whether health care providers get paid for the health care they deliver. Margot Sanger-Katz reports for the New York Times on insurers that are refusing to pay for some emergency care.
Anthem has stopped paying the bills it owes for emergency transportation and other surprise services. Not only is that bad for the transportation company and other companies providing emergency services, but it means that more than likely the company won’t be providing that transportation any longer. Most providers cannot afford to take huge financial hits.
Anthem used to pay these “surprise” bills. But, in another indicator that insurers can pretty much do whatever they want when it comes to whether to cover people’s care and pay for it, Anthem decided it wouldn’t pay the majority of arbitration awards any longer.
Sanger-Katz attributes Anthem’s refusal to pay for these “surprise” services to the No Surprises Act, which has been in place since 2022. That law gives arbitrators the right to decide how much providers should be reimbursed for the care they provide in surprise situations. It also protects patients from high bills in emergencies and other situations in which they have no choice as to who is providing the care.
For reasons that are hard to understand, arbitrators tend to award doctors and other health care providers huge payments–tens of thousands of dollars–for their services in these situations, even when the treatment they offer seems minimal. Policymakers did not expect this. Insurers are revolting.
Overall, insurers are not paying about 30 percent of the awards arbitrators issue. Anthem is not paying 74 percent of these awards, Cigna is not paying 53 percent of them and United is not paying 24 percent of them. As health policy expert Katie Keith explains, “ there’s not accountability on either side.”
Bottom line is that private health insurers have the money and the power to flout the law and not pay the awards. For sure, the awards seem excessive, and they drive up health insurance premiums. But, the insurers are literally in control of people’s lives and they are gouging Americans with insane out-of-pocket costs. This dynamic must end.
The Trump administration has the power to ensure insurers pay the arbitration awards. It can fine the insurers $100 every day that they do not pay an award. It has never done so.
Here’s more from Just Care:
- The Trump Administration’s voluntary agreements with industry: Promises, promises
- Seven reasons private health insurance can’t be fixed
- Government lets Medicare Advantage inappropriate care denials and other abuses go unpunished
- Medicare Advantage insurers face few penalties for their bad acts
- AHA underscores dangers of Medicare Advantage, need for greater accountability
