News Headlines Article

ER docs sue HHS over out-of-network payments
Modern Healthcare

The American College of Emergency Physicians is suing HHS, claiming a provision of the Affordable Care Act allows insurers to underpay for out-of-network emergency medical services.The federal lawsuit asks that insurers be transparent on the data they’re using to pay for services rendered by an out-of-network hospital.The ACA established that in these cases, insurers must pay the greatest of three costs: the insurers’ in-network amount, the Medicare amount, or the usual, customary and reasonable amount. The UCR, the amount physicians charge for care, is often the greatest of the three.