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- Massachusetts Pathologists Oppose Scrapping Payment System in No Surprises Act
The Massachusetts Society of Pathologists (MSP) strongly opposed Senate Bill 2774 which establishes a default out-of-network commercial reimbursement rate for emergency and non-emergency services. The CAP worked closely with Congress to develop the bipartisan No Surprises Act and supports MSP in its efforts to oppose the proposed legislation.
In testimony sent on April 7 to the chairs of the state Joint Committee on Health Care Financing, MSP President Rebecca Osgood, MD, FCAP, opposed the adverse legislation as it favors health insurance payers to the detriment of patients. Under federal law, Massachusetts patients receiving unanticipated out-of-network services at in-network facilities and hospitals are only liable for in-network payment amounts and are removed from billing disputes.
However, the legislation would displace the federal law by mandating payments for out-of-network services to be the median-in-network rate. Additionally, the proposed out-of-network rate is not keyed to a respective year which fails to account for inflation unlike the federal law.
The utilization of median-in-network rates to pay for out-of-network services could lead to severe consequences. For instance, such arrangements may prompt insurers to terminate contracts with physicians who are currently paid more than the median rate and serve as a disincentive to contract with physicians.
Previously, the MSP and CAP have strongly opposed these efforts in Massachusetts. In the summer of 2021, MSP had testified against establishing a default out-of-network commercial reimbursement rate for emergency and non-emergency services and urged regulators to follow the federal No Surprises Act.
The CAP and MSP will continue to partner in opposition with the Massachusetts Medical Society (MMS).