Dan Gottry - Blog

Dan Gottry's Blog

Monday, October 02, 2006

Sen. McCain Forwards Issue to Dept. of Health & Human Services

A recent letter from Senator John McCain confirms that he has sent information on to the U.S. Department of Health and Human Services, as this situation may fall within its jurisdication. You can see Senator McCain's letter at www.gottrys.com/leggo/ .

Specifically relative to Medicare and Medicaid, the U.S. Department of Health and Human Services certainly recognizes that a limited provider network can have "monopoly power" in its negotiation. It would appear that this should also be true in the case of insurance providers. This addressed this as it related to hospitals in:

Federal Register / Vol. 70, No. 18 / January 28, 2005 / Rules and Regulations 4625

We noted that in attempting to create region-wide networks, MA regional plans will be forced to bargain with hospitals that may be the only hospital (or the only hospital with a particular service or services) in a broad area. We believed that such a hospital would have a ''monopoly power'' in negotiating with plans that are, in effect, forced to contract with it in order to secure an adequate network of contracted providers with which to serve anticipated Medicare enrollees.

Hopefully this perspective has a broader scope than simply medicare!

To help make this an issue with investigating, write to:

The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C.20201

posted by Daniel Gottry at 3:09 AM