Sep 20, 2019 - Health

Arbitration for surprise medical billing may favor doctors

More evidence is piling up that when doctors and insurers sit at a table with a third-party arbiter to solve billing disputes, the outcome could benefit the doctors.

Driving the news: 2 new government reports show how arbitration, one of the solutions being considered by Congress, works in theory and in the real world.

  • New York created an arbitration process a few years ago, and doctors on average have been paid well above 80% of their billed charges in emergencies, according to an analysis of the state's report by Loren Adler of the Brookings Institution and the USC-Brookings Schaeffer Initiative. Charges are made-up figures with no relation to costs or quality.
  • Separately, creating a federal arbitration process "would be likely to result in larger payment rates to providers," especially for doctors who are already paid at higher-than-average rates, the wonks at the Congressional Budget Office said.

The bottom line: Washington has not settled on a single surprise billing solution. It’s not difficult to see why providers are pushing for a process that pays them many multiples above Medicare and average in-network rates.

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