Highmark plans to pay physicians 5 percent less while raising premiums; now medical professionals are fighting back. The Pennsylvania Medical Society reports the physician pay cut and premium hike could have a huge impact on access to care.
Here are five key notes:
1. Highmark participates in the health insurance exchange marketplace; the marketplace dynamics are still unstable and last year the company reported loss on the federal market place.
2. The company restated commitment to stabilizing the ACA line of business as the reason for adjusting its fee schedules, which are expected to go into effect on April 1. The company reports taking multiple actions over the past few years and using significant revenues to make the plan sustainable.
3. The patients many ACA plans cover didn’t have insurance before the marketplace was created, and required uncompensated care.
4. Highmark previously offered the Special Care products, where physicians received 27.5 percent lower reimbursement rates than the commercial rate for the underinsured population.
5. Healthcare providers are concerned the cuts will narrow providers available to see patients with Highmark insurance.
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