Health Plan Weekly

The cost of emergency ground ambulance trips has risen considerably in recent years, according to recent research, and experts tell AIS Health that payers have limited power to push back. Nevertheless, the issue has caught the eye of policymakers amid a larger push to increase health care cost transparency and eliminate surprise medical billing, signaling that change may be on the horizon.

From 2017 to 2020, average charges and allowed amounts for both basic life support (BLS) and advanced life support (ALS) emergency ground ambulance transport increased, according to a new white paper from the nonprofit claims-data research organization FAIR Health.

Maine will merge its small-group and individual exchange health insurance markets starting in plan year 2023. Experts tell AIS Health, a division of MMIT, that the move is a bid to stabilize small-group premiums, which have gone up in recent years.

According to a Feb. 15 press release from the state’s Bureau of Insurance, “the merger, which will pool the risks of the two markets and roll the Small Group coverage into the Maine Guaranteed Access Reinsurance Association (MGARA), is projected to reverse the trend of steady premium increases and declining enrollments in Maine’s Small Group Market, while supporting continued stable pricing in the Individual Market.”

On Feb. 23, health insurer trade group AHIP hosted a virtual State of the Industry presentation, reviewing progress made in 2021 and important issues for the health insurance industry as it looks to a world beyond the COVID-19 pandemic.

Matt Eyles, president and CEO of AHIP, opened the conversation with a look at the organization’s 2021 initiatives and hopes for 2022. Eyles stressed the importance of the No Surprises Act, which aims to protect consumers from surprise medical bills. The legislation went into effect on Jan. 1, but it is currently the subject of a number of lawsuits filed by organizations including the American Hospital Association and American Medical Association (see box, p. 5). “AHIP continues to fight and protect the law,” Eyles said during the presentation.

Texas providers have notched their first win in the legal battle over the No Surprises Act (NSA), the federal law that bans surprise billing — though the Biden administration can appeal the decision. In a lawsuit brought by the Texas Medical Association (TMA), Judge Jeremy Kernodle of the federal Eastern District of Texas on Wednesday struck down regulations issued by the Biden administration that providers allege favor insurers at their expense in balance-billing scenarios.

The NSA requires payers and providers to work out the balance billing disputes between themselves. If that fails, an HHS-approved independent arbitrator will decide between two payment amounts: one submitted by the provider and one by the insurer. Arbitrators then pick between one of the two proffered amounts using criteria designed by the Biden administration.