Explore the changes in the healthcare reimbursement landscape arising out of the proliferation of narrow network and tiered insurance plans, and the corresponding increases in the numbers of providers choosing to "go out of network." Non-contracted providers frequently offer fee discounts and other waivers of patient financial responsibility as a means of gaining or retaining (after a contract termination) market share. In the first portion of our discussion we will explore the successes and failures of various legal theories that plans are increasingly advancing to deter referrals to out-of-network providers. In the second portion we will examine recent federal and state efforts to limit patient exposure to "surprise billings" and other forms of balance billing (including ACA reforms for out-of-network coverage of emergency medical services).
Recorded at A Day on Health Law in October 2019.