- Currently, some healthcare systems require a large out-of-pocket cost if members do not use a designated group of doctors, pharmacists, or hospitals.
- However, health care registrars have issued new notices stating that these out-of-pocket costs will be limited in the coming months.
- The healthcare system also needs to follow new rules in deciding who can be designated as a service provider.
If members do not use a designated group of doctors, pharmacists, or hospitals, there are crackdowns on the high out-of-pocket costs required by some healthcare systems.
Currently, many members are forced to use only a limited number of selected service providers or are at risk of paying “exorbitant” out-of-pocket payments, the Health Care Council (CMS). Says.
But With a new notice published in the government bulletin, Healthcare Registrar has announced that some of these practices are currently “undesirable.” This includes “out-of-pocket costs that are unfair to members or beneficiaries or otherwise cannot be numerically justified.” Healthcare plans “exceed the difference between what is billed by a designated service provider of the healthcare system and what is billed by a provider who is not a designated service provider of such a health care system” You are not allowed to do so.
The CMS will publish new out-of-pocket guidelines within the next few months.
In addition, the healthcare system needs to prove “fair, impartial, transparent, competitive and cost-effective” in selecting preferred providers for diagnosis, treatment and care of prescribed minimum benefit conditions. there is. New guidelines for choosing a designated service provider will also be published in the coming months.
According to the CMS, some healthcare systems currently do not engage in a fair procurement process and do not consider applications from all qualified service providers, and “one side” the criteria for choosing a dedicated service provider. Is decided.
“(This) unreasonably limits the number of service providers selected. [including pharmacies] It is available to provide healthcare services to members. “
According to the CMS, this has designated a scheme for many healthcare service providers, including independent community pharmacies, despite their willingness and ability to offer healthcare services at the same rates as the service providers of their choice. I can no longer join the network.
Good news for health care members: New rules may curb some sudden out-of-pocket costs
Source link Good news for health care members: New rules may curb some sudden out-of-pocket costs