Patient billing legislation pits docs against CareFirst
Published: 2010-07-10 22:06:08By: C. Benjamin Ford | Gazette.Net | March 19, 2010
ANNAPOLIS — A bill moving through the State House is pitting physicians against insurance companies over a billing practice that the state's largest insurer says is needed to keep doctors in their network and health care costs affordable for small businesses and their workers.
If an assignment of benefits bill passes and becomes law, CareFirst Inc. executives warn many doctors will decide to leave the insurance company's network. That, they claimed, would result in more patients being treated by physicians outside of the network, which in turn would lead to higher bills for the patients.
The Senate passed its version of the bill Monday, 37-9. The House Health and Government Operations Committee has yet to take its vote on the matter.
At a recent Health and Government Operations hearing, CareFirst Chairman Michael R. Merson said that if 10 percent of the physicians and specialists in the CareFirst network decided to leave, the people covered by CareFirst could end up spending $220 million in out-of-pocket expenses.
But an official from MedChi, the state medical society, said CareFirst officials were exaggerating the potential consequences and that many physicians would continue to remain in the insurance company's network.
"Despite these grim exaggerations, CareFirst has been unable to point to a single state where an [assignment of benefits] law passed and the supposed network apocalypse occurred," said Gene M. Ransom III, MedChi's executive director.
The reason physicians, particularly specialists, do not participate in CareFirst's network is because of CareFirst's "abysmal rates" for reimbursement, Ransom said.
"The simple way to have all doctors be in [network] is to pay fair and reasonable rates," Ransom said. Twenty-four other states have passed assignment of benefits laws because it makes it easier for claims handling by doctors and doctors continue to remain in insurance company networks, Ransom said.
CareFirst spokesman Kevin Kane said insurance "is a filter of true medical costs as there is in our market."
"Ultimately we'd want the doctor to negotiate a rate whether in-network or not," Kane said.
The bill would allow patients to have the checks sent directly to a doctor or medical specialist when the doctor or medical specialist is not in the insurance company's network of providers.
CareFirst sends the check to the patient directly when the doctor or specialist is not in the CareFirst network and then the patient is expected to pay the medical bill.