The federal No Surprises Act, designed to protect consumers from surprise out-of-network medical bills, may wind up lowering prices for certain services, according to a new study.
With support from The Commonwealth Fund, researchers with Columbia University and Weill Cornell Medical College compared prices paid for anesthesiology services in three states — California, Florida, and New York — that had passed surprise-billing legislation with prices paid in 45 states that had not passed such laws. The research team analyzed more than 2.7 million claims from hospital outpatient departments and ambulatory surgery centers for patients in preferred provider organizations and point-of-service plans from 2014 to 2017. The claims involved in-network anesthesiologists as well as out-of-network anesthesiologists at in-network facilities. The study focused on claims for three large U.S. health plans (Aetna, UnitedHealthcare, and Humana), rather than all commercial claims.
The study found that after Florida, California, and New York enacted surprise-billing laws, prices paid to anesthesiologists for outpatient services decreased. The results suggest that surprise-billing laws may have an impact on in-network contract negotiations between payers and providers. Anticipating the passage of surprise-billing laws also could spur preemptive contract talks.
- Have Surprise-Billing Laws Lowered Health Care Prices? The Case of Outpatient Anesthesia. The Commonwealth Fund. August 16, 2021
- Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York. JAMA Internal Medicine. May 1 2021