Q. Why not just require all physicians at a given health care facility to be in-network? That is to say, why not require physicians at a given hospital to accept all of the plans covered by the hospital as part of their credentialing requirement? | Physicians For Fair Coverage

A. Such requirement is as incomplete as it is ineffective. First and foremost, it does not solve the problem of balance billing. For example, hospitals cannot feasibly have a contract with every insurance company and every insurance plan so there will undoubtedly be cases where patients are surprised to learn they are out-of-network. More problematic, requiring physicians at a given health care facility to accept all of the health care plans of that facility would result in coercive contracting, not to mention it would also likely run afoul of applicable state and federal anti-trust laws. The direct impact of this would be to push many physicians, who would be required to accept take-it-or-leave-it deals, out of hospitals. This dynamic only promises to exacerbate ongoing issues, including patient access to quality care.

Assurances that insurers must negotiate in “good faith” are virtually unenforceable and will do little to alleviate concerns with this provision given the wide variations in contracted amounts between insurers. Take, for example, data in Georgia. Based on data collected by the Department of Insurance, one ED service showed insurers contracting for as little as $70.96 for the level 4 ED service with other insurers contracting for the same service at $2,411.61. This wide discrepancy illustrates that many insurers are not currently negotiating in good faith and are unlikely to do so in the future.

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