This week saw some movement in Congress to advance legislation to address surprise medical bills. It's an issue that deserves our attention and needs to keep moving through the legislative process.
More than half of Americans have received a surprise medical bill, meaning a charge that arose because an insured person unknowingly received care from an out-of-network provider, often while receiving emergency care services.
Far too many Americans, including those who have faithfully paid their monthly health insurance premiums, find themselves needing emergency care only to discover later that some services provided to save their lives were deemed out-of-network and disqualified for coverage, leaving them stuck owing thousands of dollars.
This happened to Drew Calver, a teacher in Texas who suffered a heart attack and had stents implanted to save his life. His health insurance covered $55,000 worth of his care, but he was billed for more than $100,000 in medical services the insurance company declared out-of-network.
Calver had no way of knowing he was receiving care his insurance company would later say his plan didn’t cover. And during a heart attack, should he be expected to ask those questions? Of course not.
For too long, insurance companies have wielded incredible power over patients by creating complicated systems that are difficult to navigate and provide narrow options. As Congress tackles health care reforms, there should be checks on the power of insurance companies. Doctors and hospitals should be fairly compensated for the care they’re delivering. This is especially important in our rural communities where reimbursements that fully cover costs are even more critical to sustaining local hospitals and physician clinics.
The solution to addressing surprise medical billing isn’t complicated. New York and Texas implemented legislation at the state level to address surprise medical billing. Since its implementation in 2015, surprise medical bills in New York declined by 34% with no evidence premiums have increased. Both states use an independent dispute resolution (IDR) process, which means when cost disputes arise, the doctors and insurance companies use a third-party mediator to determine payment.
It’s not a solution insurance companies favor, and they’re lobbying Congress against an IDR, favoring a fixed-rate reimbursement that many providers fear will diminish networks and reduce access to care, especially in rural regions.
During a lifesaving emergency or a routine surgery, patients and their families shouldn’t have to fear surprise charges that could send them into bankruptcy. Congress should accelerate its efforts to stop surprise medical billings by passing a law that removes patients from the billing disputes, provides an independent resolution process, increases transparency from insurance companies on services covered and ensures health care professionals receive a fair payment for their services.