Anti-Trust and Fees

ACA often receives concerns from providers regarding reduced fees or fee schedule changes implemented by insurers. ACA is a nonprofit professional association and vigilantly follows anti-trust regulations, which forbid discussion or organization about fees and pricing information 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.

In addition, ACA is prohibited from permitting discussion of any term, condition or requirement upon which any chiropractor deals or is willing to deal, with any payor; or any intention or decision with respect to entering into, refusing to enter into, threatening to refuse to enter into, participating in, threatening to withdraw from, or withdrawing from any existing or proposed participating agreement with any third-party payor or vendor.

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.