Jackson Hammond and Brian Blase’s Oct. 18 op-ed, “A $17 billion surprise bill for Americans,” argued the No Surprises Act’s arbitration system is driving up health care costs, but they missed the root cause driving disputes.
I am a practicing emergency physician, and I’ve never met a colleague who said they view arbitration as a business model. But it becomes necessary when insurers terminate network contracts to make lowball payment offers to physicians who treat patients in emergencies, regardless of their ability to pay.
The op-ed, which detailed the new Paragon Health Institute analysis, argued that independent arbitrators side with providers in roughly 85 percent of disputes. But that statistic deserves context. In one study, which was backed by the Americans for Fair Health Care coalition, insurers’ qualifying payment amounts were set at $0 in more than 20,000 disputes, and in almost 1,000 others, they were set at less than $1.
Meanwhile, more than 20 percent of the time, insurers delayed paying arbitration awards or failed to participate, leaving physicians waiting to be paid for care they had already provided.
Paragon argues that physicians use arbitration to demand higher rates. My organization, TeamHealth, has seen awards below what insurers paid for the same services in 2019.
Health care systems would rather work under fair, stable in-network agreements, but persistent underpayments make it harder to recruit and retain clinicians and negotiate sustainable contracts, contributing to narrower networks and reduced access to emergency care.
Congress should preserve the No Surprises Act’s patient protections, require insurers to comply with arbitration decisions and address the payment practices that make arbitration necessary.
Jody Crane, Richmond
The writer is the chief medical officer for TeamHealth.
Every single day in America, someone experiences a life-threatening event that requires an air ambulance to keep them alive and get them to a hospital that can provide the appropriate level of care. Teams of dedicated medics, nurses and pilots are on duty 24/7 to respond to emergencies. But these services are critically undervalued by health insurance companies.
As important as the No Surprises Act is for protecting patients, it lacks the enforcement mechanisms needed to ensure emergency care providers are reimbursed.
Unfortunately, a growing number of payers are refusing to pay the outstanding claims that independent arbitrators have determined they owe — decisions which are legally binding and must be paid within 30 days. To date, insurers owe my company, PHI Health, more than $50 million in unpaid independent dispute resolution awards for emergency care already delivered.
This enormous burden has forced us to suspend operations at one base in rural California and threatens the future of air ambulance services. Insurers’ failure to respect the law could eventually leave many communities without air medical services, a situation Congress hardly intended.
The No Surprises Act needs more teeth to ensure that insurance companies follow the law and that claims owed are paid promptly.
Paul Julander, Tempe
The writer is co-president of PHI Health.
Washington needs AI reports
Asha Jadeja’s Oct. 20 op-ed, “The U.S. and China need an arms control pact — for AI,” underscored a blind spot in American statecraft. Washington needs reliable access to the information it promises to share.
Much of the frontier artificial intelligence development in the United States occurs in commercial labs. Yet the federal incident response practices issued Oct. 16 do not themselves impose mandatory reporting deadlines.
A bilateral pact needs reliable domestic reporting arrangements. Negotiators should secure reciprocal commitments, and Congress should establish clear statutory duties for designated U.S. developers to report defined dangerous capabilities and serious security breaches within specified deadlines. This requires a designated federal recipient and secure channels protecting confidential commercial information so authorities can assess the evidence behind international assurances.
The government should also maintain 24/7 technical triage to assess preliminary reports and issue proportionate warnings before responsibility for an incident is established. Waiting to identify a culprit could delay containment. Presidents cannot relay warnings their governments never receive.
Rohan Sharma, Temecula, California
The writer is the U.S. delegate to the joint International Organization for Standardization and International Electrotechnical Commission committee on artificial intelligence.
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