Dive Brief:
- Private-equity backed Envision Healthcare and Cigna have reached a deal to retain the physician services group in the insurer's network in Florida.
- Envision has a network of more than 6,000 clinicians including anesthesia, emergency medicine, radiology, neonatology, surgical and office-based healthcare in the state, the company said Wednesday.
- The multi-year agreement ensures that Cigna's commercial and exchange member will have uninterrupted in-network access to Envision clinicians.
Dive Insight:
The deal averts a situation where thousands of clinicians would have been out-of-network during a deadly pandemic, raising the potential for surprise medical bills.
Surprise billing typically occurs when a patient goes to an in-network facility but a clinician they encounter inside the facility is actually out-of-network.
It's not an uncommon problem. Nearly two-thirds of hospitals in the U.S. outsource their emergency department to outside groups, according to a paper from Yale researchers.
Envision also had a reputation for remaining outside insurer networks, or not agreeing to in-network deals.
In many instances, incentives are lacking for the physician groups to want to be in-network, the paper notes, which studied TeamHealth and EmCare, which is owned by Envision.
The groups either go out-of-network for a few months "and then rejoin networks while using the now credible threat of out-of-network status to secure higher in-network payments," the paper noted. Or they exit networks and and then "seek to collect their charges (which they also raise by 96% relative to the charges billed by the prior physician group in that hospital)."
These practices then leave patients stuck in the middle, forced to figure out how to pay the difference between what the insurer is willing to pay the out-of-network provider and the remainder of the bill.
Public scrutiny of these practices put pressure on Envision to change its ways.
"By year-end 2017, EVHC had shifted 40% of EmCare’s out-of-network care to in-network by signing contracts with insurance companies that EmCare had not been willing to contract with in the past," according to a paper from Harvard's T.H. Chan School of Public Health.
The nation's largest commercial insurer has also put the squeeze on physician services firms for these practices.
In 2018, UnitedHealthcare threatened to drop Envision, arguing the firm was responsible for driving up healthcare costs, according to a letter United sent hundreds of hospitals across the country. The two eventually agreed to terms at "materially lower" rates for Envision, according to a note from S&P Global analysts at the time.
Still, despite bipartisan backing to nix surprise bills, a formal fix has been put on the back burner as the nation deals with a deadly pandemic.
Last year, a congressional fix was close but was ultimately scuttled by industry efforts.
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October 22, 2020 at 09:49PM
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Envision, Cigna avert out-of-network status in Florida - Healthcare Dive
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