ER docs sue HHS over out-of-network payments

From Modern Healthcare:

The American College of Emergency Physicians is suing HHS, claiming a provision of the Affordable Care Act allows insurers to underpay for out-of-network emergency medical services.

The federal lawsuit asks that insurers be transparent on the data they’re using to pay for services rendered by an out-of-network hospital.

The ACA established that in these cases, insurers must pay the greatest of three costs: the insurers’ in-network amount, the Medicare amount or the usual, customary and reasonable amount. The UCR, the amount physicians charge for care, is often the greatest of the three.

Insurers previously have been accused of manipulating UCR figures to lower their obligation, leaving patients with a greater amount to pay out of pocket. Some states require the ER physician to accept the insurers’ payment, even if it is far below the doctor’s set fee.

The ACEP is asking the federal government to overturn and amend the provision

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