Anti-Trust

ACA often receives concerns from providers regarding reduced fees or fee schedule changes implemented by insurers. ACA, as a trade association, must vigilantly follow anti-trust regulations which address what types of fee and pricing information can be collected and/or shared between providers and other groups. ACA is prohibited, by anti-trust laws, from gathering or disseminating any current data that would indicate an appropriate dollar figure for any given treatment or procedure. There are independent surveying organizations that may provide such information. Additionally, some third party payers and some state workers’ compensation programs may be able to provide such information.

The Federal Trade Commission very clearly outlines their enforcement policy on providers' collective provision of fee-related information to purchasers of health care services. Providers are not completely restricted from discussing fees with fellow providers but providers must be aware of anti-trust regulations which dictate when discussions of fees violate anti-trust regulations. ACA urges providers and state associations to become familiar with the “safe harbor” situations in which it is legally sound to discuss provider fees.  Resources on this topic can be found here.