Department of Health & Human Services – “All Carriers Must Contract With Essential Service Providers”

Under ObamaCare, carriers that participate in Exchanges “must contract with essential service providers.” Will that incentivize providers to charge more? “You want me in your lousy network? Then I want 500% of RBRVS and not a penny less!” Why should providers negotiate  lower fees when insurance companies are required to use their services? Just the opposite may happen

The following is  an excerpt from an Aetna report received this morning:


Aetna participated in one of two “Exchange Listening Sessions” hosted by the Department of Health and Human Services (HHS) for community organizations and nongovernmental stakeholders. The meeting opened with an overview of the Notices of Proposed Rule Making (NPRM) on Exchanges, Plan Standards, Eligibility and Enrollment; Medicaid Eligibility and Enrollment and Tax Credits. Comments from advocacy groups essentially called for the following:

  • Seamless interfacing of the eligibility system for Medicaid recipients, particularly the population impacted by the coverage expansion
  • Credentials of Navigators (requiring more from community groups to avoid broker dominance)
  • Parameters to constrain states from using flexibility as a guise to retreat from ACA requirements
  • Improved foreign language translations of the material on the HHS website
  • Stricter scrutiny of exchange board membership
  • Alignment of Medicaid eligibility/enrollment rules with an exchange open enrollment period
    Integrating the exchanges with other public service agencies
  • Requiring all carriers to contract with essential service providers

Joel Ario, Director, Office of Health Insurance Exchanges, remarked that the overarching goal of the exchanges was to expand consumer protections through greater transparency. His response to concerns about adverse selection was to point to the availability of the “young invincible” policy and the “3 Rs” — risk adjustment, risk corridors and reinsurance — as solutions. Regarding the potential for exchange products to not be affordable, Ario said the goal of the exchanges is solely to expand access and that the cost issue will be addressed by exchanges becoming “active purchasers”.

Editor’s Note: Universal health care is almost here. Carriers will exit the market and seek profits on P&C side instead. Home owners policy through Blue Cross? Auto through Humana? Business overhead cover through Cigna?

“So whats the problem?” – San Antonio physician