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JAMA: negative effect of in-network reimbursement when Surprise Billing Legislation is introduced

Researchers recently published an article in JAMA showing that in-network reimbursement rates dropped with the introduction of surprise billing legislation.

The JAMA article by La Forgia et al, "Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York An Economic Analysis" is a retrospective study of over 2.5 million claims filed with health insurers in states where Surprise Billing legislation was introduced: NY, CA, and FL.

They found that "that prices paid to in-network and out-of-network anesthesiologists in hospital outpatient departments and ambulatory surgery centers decreased after the introduction of surprise-billing legislation, providing early insights into how prices may change under the federal No Surprises Act and in states that have recently passed their own legislation." In-network reimbursement rates dropped when legislation was introduced. The negative impact on reimbursement was most significant in states that proposed (and implemented) Benchmarking to address Surprise Billing. This is consistent with multiple reports from independent physician groups who have had their contracts terminated, been dropped 0ut-of-network, and had reimbursement rates significantly lowered whenever surprise billing legislation was introduced in their state and/or at the Federal level.


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