- Home
- Advocacy
- Latest News and Practice Data
- Massachusetts Pathologists Urged State to Follow Federal ‘No Surprises Act’
With assistance from the CAP, the Massachusetts Society of Pathologists (MSP) recently testified in opposition to the establishment of a default out-of-network commercial reimbursement rate for emergency and non-emergency services. The CAP worked closely with Congress and other stakeholders to develop the bipartisan No Surprises Act, creating an equitable arbitration process to determine how much insurers must pay out-of-network providers.
In comments before the state’s Executive Office of Health and Human Services, MSP’s Immediate Past President David Gang, MD, FCAP, urged state regulators to follow the federal “No Surprises Act,” which was enacted December 27, 2020, with bipartisan congressional support.
“The federal law, which does not stipulate a default payment rate, provides a robust arbitration process for resolving claim disputes between health insurance payers and health care providers,” Dr. Gang stated at the June 24 listening session.
The federal law balances stakeholder interests to ensure the continued functioning of the commercial insurance market while preserving the economic incentive for health plans to contract with health care providers. “With respect to pathology and laboratory services and the patients we serve, we believe the optimal way to preserve access and high quality in these services is through in-network contracting,” Dr. Gang said.
Dr. Gang added that using a default rate for out-of-network payment that is substandard or incentivizes health plans not to contract with pathology and laboratory providers will undermine the basic rationale for maintaining the private insurance market. In addition, an inadequate payment will further aggravate problems of network adequacy.
“To independently craft an out-of-network payment methodology that disrupts the commercial contracting market and favor health insurance plans will only serve to enrich their shareholders and corporate executives,” said Dr. Gang. “It is precisely for that reason that the vast majority of states that have enacted out-of-network billing laws over the last five years do not prescribe a payment methodology and were thus conceptually aligned with the No Surprises Act even before its passage last year.”
Dr. Gang urged regulators to allow the federal law to take full effect for ERISA and non-ERISA plans before making changes to state law and allow time to evaluate what MSP believes will be a successful transition.