Anesthesiologists accuse Blue Cross insurer of strong-arm tactics linked to surprise medical bill rule

Woman tears agreement documents in front of agent
An anesthesiology group is charging Blue Cross Blue Shield of North Carolina with using a surprise medical bill rule to get pay cuts out of physicians. (Getty/BernardaSv)

An anesthesiology advocacy group is charging that Blue Cross Blue Shield of North Carolina is demanding physicians take a pay cut as part of its implementation of a law banning surprise medical bills.

The American Society of Anesthesiologists accused the insurer in a release Monday of abusing the federal law that is being implemented by the federal government next year.

The society charges that the insurer sent letters to anesthesiology and other practices in the state threatening to terminate their contract if they don’t immediately agree to a pay cut of 10% to 30%, a release on the matter said.

“Implementation of the No Surprises Act is cited in the letters as the impetus for the reductions,” the release said. “The clear intent of the insurance company in taking this action is to improve its negotiating position against community physician practices in the dispute resolution process outlined in the recently released interim final rule implementing this legislation.”

The accusation comes as providers are fighting the latest interim final rule that outlined the dispute resolution process to be used if payers and providers can’t reach an agreement on an out-of-network charge.

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A payer and provider are supposed to offer their preferred amounts to a third-party arbiter, which will settle the dispute. But the final rule says the arbiter should pick the amount that is closest to a qualifying payment amount, which is the geographic rate for the service.

Providers and dozens of lawmakers charged that the rule goes against the intent of the law, which did not call for a benchmark rate to be used. An air ambulance provider group has also sued the Biden administration in federal court in an attempt to strip parts of the rule.

Blue Cross Blue Shield of North Carolina told Fierce Healthcare that it sent letters to 54 of its most expensive provider practices in the state, a small percent of the thousands of contracts it has with providers.

"Prior to new consumer laws that protect patients from surprise billing, even in-network providers in specialties like anesthesiology, radiology and emergency have been able to charge our members significantly higher than their peers in North Carolina and up to 500% higher than what they charge Medicare patients," the insurer said.

The American Society of Anesthesiologists said the insurer is taking actions others will surely follow.

“Insurance companies are threatening the ability of anesthesiologists to fully staff hospitals and other healthcare facilities,” said Randall Clark, M.D., the group’s president. “Left unchecked, actions like these of Blue Cross Blue Shield of North Carolina will ultimately compromise timely access to care for patients across the country.”

Department of Health and Human Services Secretary Xavier Becerra defended the interim regulation in an interview with NPR, saying providers need to stop overcharging patients and that some providers have taken advantage of a complex system to charge extremely high rates.