Insurers will do just about anything to make a buck.
Including taking money owed to physician practices and hospitals.
According to an article from ProPublica, insurers take cuts from physician reimbursements if physicians opt to receive their funds electronically rather than through paper checks.
But it wasn’t supposed to happen like this.
After the passing of the Affordable Care Act in 2010, lawmakers encouraged the use of electronic payments because they’re faster and easier to process than checks. Despite the best intentions, the Centers for Medicare & Medicaid Services (CMS) heard complaints from doctors about fees for direct deposits.
“An industry of middlemen had begun sprouting up, processing payments for insurers and skimming fees off the top. Sometimes they shared a portion of the fees with insurers, too. The middlemen companies say they offer value in return for their fees and insist that it’s easy to opt out of their services, but doctors say otherwise,” reports ProPublica.
In 2017, CMS posted a notice on its website explaining that the purpose of electronic payments was not for making profits. But the notice was short-lived: six months later, it was removed from the CMS website.
The article explains why — eventually, public records showed that CMS backed down due to the actions of one industry lobbyist.
Matthew Albright, the lobbyist, worked at CMS, in the same division that implemented the electronic payment rule. But Albright switched sides, moving to a company that handles electronic payments for hundreds of payers.
And how did he use his CMS knowledge at his new gig?
“Albright protested the notice prohibiting fees and demanded that CMS revise the document.” Then, the article outlines, he “used an artful combination of cajoling, argument and legal threat.”
Here at Un-covered, when we hear the word “middlemen,” we can’t help but think of pharmacy benefit managers (PBMs), who negotiate drug prices on behalf of health insurance companies. Although PBMs are supposed to increase price transparency and minimize consumer cost, PBMs end up taking a portion of the pie for themselves through methods like clawbacks and spread pricing. In other words, PBMs bill higher for what drugs actually cost and pocket the difference. Oh, and the big three PBMs are actually owned by insurance companies.
Whether it’s electronic payment processing fees or pharmaceutical negotiations, lobbyists have continued to find opportunities to skim dollars off the top for insurance companies, while making patient care harder for providers.