Reports from Duke University Provide New Insights into Managed Care (Battling the Chargemaster: A Simple Remedy to Balance Billing for Unavoidable…

Reports from Duke University Provide New Insights into Managed Care (Battling the Chargemaster: A Simple Remedy to Balance Billing for Unavoidable Out-of-Network Care)

By a News Reporter-Staff News Editor at Insurance Weekly News -- Investigators publish new report on Managed Care. According to news reporting originating in Durham, North Carolina, by VerticalNews journalists, research stated, "To develop an effective legal mechanism to combat chargemaster abuses and to facilitate price transparency. Applying legal doctrines to out-of-network (OON) billing disputes."

The news reporters obtained a quote from the research from Duke University, "We reviewed rudimentary contract law and examined the law's handling of contracts where prices have not been specified in advance. These cases are the controlling authority to guide courts, handling of surprise and OON billing problems. We then compared legal remedies that correct OON billing abuses to prevailing legislative and regulatory approaches. Our analysis suggests that providers have no legal authority to collect chargemaster rates from surprise and OON billing abuses. A proper application of contract law can end such abuses and would facilitate superior pricing incentives to other strategies designed to end balance billing disputes. Chargemaster rates on uninsured and OON patients impose significant financial burdens on the vulnerable, distort medical prices, and inflate healthcare costs. Applying rudimentary contract law to these practices offers a solution that is simpler and more effective than other administrative and legislative schemes recently adopted in several states. It will prevent providers from hiding behind a convoluted hospital pricing system, encourage the development of attractive narrow-network insurance products, and shield urgently sick individuals from the dread of medical predation."

According to the news reporters, the research concluded: "Patients and payers should know that they are under no obligation to pay surprise bills containing chargemaster rates, and state attorneys general can use the law to prevent providers from pursuing chargemaster-related collection efforts against patients."

For more information on this research see: Battling the Chargemaster: A Simple Remedy to Balance Billing for Unavoidable Out-of-Network Care. American Journal of Managed Care, 2017;23(4):E100-E105,8-15. American Journal of Managed Care can be contacted at: Managed Care & Healthcare Communications Llc, 666 Plainsboro Rd, Ste 300, Plainsboro, NJ 08536, USA.

Our news correspondents report that additional information may be obtained by contacting B.D. Richman, Duke University, Fuqua Sch Business, Durham, NC 27706, United States. Additional authors for this research include N. Kitzman, A. Milstein and K.A. Schulman.

Keywords for this news article include: Durham, North Carolina, United States, North and Central America, Managed Care, Duke University.

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