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Monday, January 6, 2014


Just as we’re finally starting to get a handle on silent PPOs here in Texas, the feds are coming up with a new kind of surprise network for physicians who don’t want to participate in ACA exchange marketplace health plans. But we’re not going to let them get away with it. We wrote a tough letter to the U.S. Department of Health and Human Services (HHS) strongly opposing a proposed new federal policy that amounts to a “government grab at discount health care services.” The proposed policy “strongly encourages” health plans to treat any out-of-network physician as in-network if the plan incorrectly lists that physician in its directory. We all know how notoriously inaccurate those directories are — and there’s no telling how much worse they might be for the exchange plans. This policy would be bad news for patients and physicians. We call on HHS to rescind it and to enact new rules that would make sure out-of-network physicians get paid based on billed charges. Our legal and policy staff were busy throughout December. We also filed comment letters with the Texas Department of Insurance expressing concerns about changes in prompt pay rules and about proposed regulations governing captive insurance companies.

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