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There are some guardrails. While mediators can’t use Medicare and Medicaid reimbursement rates as their starting point (which would be the commonsense place) they also have to throw out the high charges providers use for providing care, as opposed to the rates they negotiate with insurers. Not allowing “billed charges” as the benchmark rate is a win for insurers. Zack Cooper, an associate professor of public health and economics at Yale who studies healthcare pricing told Kaiser Health News that providers’ bill charges “are totally made up. […] So, the big deal is that arbitrators are not considering charges.”
“No law is perfect,” Cooper said. “But it fundamentally protects patients from being balance-billed,” the industry term for surprise billing from out-of-network medical providers. “That’s a remarkable achievement.” But the millions of dollars spent by provider lobbyists is a horrifying preview for what’s to come when Biden tries to push for the reforms he’s considering, like a public option on the Obamacare exchanges.
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