Premier Submits Statements to House Committees Examining Health Plan Practices

Premier submitted statements for the record to both the House Ways and Means Committee and the Energy and Commerce Subcommittee on Health as lawmakers review health plan practices and their effects on patient care during Jan. 22 hearings. In its comments, Premier underscored that significant opportunities exist to enhance patient care by improving the operational dynamics between providers and payers. Premier shared results of its survey that shows concerning trends with claims adjudication processes, including initial denial rates across private payers and government-managed plans, the high rate at which denials are ultimately overturned, the administrative waste created by burdensome appeals processes, distortion of hospital quality scores, the significant cost to providers, and the downstream impact on patient outcomes.

To address these issues, Premier urged Congress to advance bipartisan reforms that promote stronger CMS enforcement, greater transparency, and broader adoption of technology-enabled solutions to reduce administrative burdens. Premier specifically called for passage of the Prompt and Fair Pay Act (H.R. 4559) – supported by more than 100 organizations – which would establish prompt payment standards for Medicare Advantage plans and help ensure that claims are processed accurately, consistently, and in a timely manner.