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Illustration: Lazaro Gamio/Axios

The problem of surprise medical billing — which Congress failed to solve last year — is about to get worse, thanks to a feud between an insurance giant and a company that employs thousands of doctors.

The big picture Parents who have babies in intensive care, women with high-risk pregnancies and people who need anesthesia could receive unexpected bills in the mail as a result of the fight between Mednax, the physician-staffing firm, and UnitedHealth Group.

Where it stands: Certain Mednax doctors could be out of UnitedHealth's network as early as March, forcing UnitedHealth customers to pay the full cost if they see one of those doctors.

  • Mednax's anesthesiologists, neonatologists and obstetricians will be out-of-network for UnitedHealth patients at staggered dates throughout this year in four states: Arkansas, Georgia, North Carolina and South Carolina.
  • Arkansas, Georgia and South Carolina don't have any surprise-billing protections for patients, according to the Commonwealth Fund, while North Carolina has limited protections.

What they're saying: Mednax CEO Roger Medel said on an earnings call that UnitedHealth's terminations "were unilateral, without warning and unprecedented," and that he has reached out to UnitedHealth CEO Dave Wichmann.

  • Medel also said Mednax's "administrative costs of processing those bills and the time and stress for patients receiving and resolving these bills will increase meaningfully," and he is "concerned how these actions may interfere with the ongoing discussions in Washington surrounding surprise billing."

The other side: UnitedHealth says Mednax doctors simply charge too much.

  • "Mednax's charges are more than 60% higher than the average cost of the other doctors that provide similar services in these states," a UnitedHealth spokesperson said.
  • UnitedHealth said it submitted proposals for lower payment rates to Mednax's doctors in Georgia, North Carolina and South Carolina in November and submitted a proposal to Mednax's doctors in Arkansas this month, but never received any counteroffers.
  • Mednax sent a statement to Axios saying UnitedHealth presented payment terms on a "take-it-or-leave-it basis" and rejected Mednax's request for a 60-day extension.

While the two sides argue, expect more billing horror stories.

The bottom line: This is the marketplace the industry has built, and it will continue to shock unwitting patients and raise premiums until lawmakers and regulators land on a solution.

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Between the lines: Tech knows it will be held accountable for any further violence that turns out to have been planned online if it doesn't act to stop it.

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Why it matters: This announcement was predictable, as the election was neither free nor fair and Museveni had no intention of surrendering power after 35 years. But Wine — who posed a strong challenged to Museveni, particularly in urban areas, and was beaten and arrested during the campaign — has said he will present evidence of fraud. The big question is whether he will mobilize mass resistance in the streets.

Off the Rails

Episode 1: A premeditated lie lit the fire

Photo illustration: Sarah Grillo/Axios. Photo: Chip Somodevilla/Getty Images

Beginning on election night 2020 and continuing through his final days in office, Donald Trump unraveled and dragged America with him, to the point that his followers sacked the U.S. Capitol with two weeks left in his term. Axios takes you inside the collapse of a president with a special series.

Episode 1: Trump’s refusal to believe the election results was premeditated. He had heard about the “red mirage” — the likelihood that early vote counts would tip more Republican than the final tallies — and he decided to exploit it.

"Jared, you call the Murdochs! Jason, you call Sammon and Hemmer!”