No matter what side of the aisle we sit on, we can all agree that surprise medical bills are bad for everyone. Patients are on the receiving end of big bills because when insurance companies refuse to pay for medical care, this often leaves the patient on the hook for major expenses through no fault of their own.
I know all too well how a family can be impacted by a catastrophic medical emergency. In December of 2013, I got the flu. It shut down my body from processing oxygen and the only way the doctors could save me was to put me in a coma and on a life support machine. Due to the illness attacking my organs, I had to receive a full blood transfusion and was on dialysis due to kidney failure.
My chance of survival was less than 3 percent. When I was in the hospital, we didn’t talk insurance or in-network vs out-of-network. We just talked about saving my life.
After I came out of the coma, I had a long 3-month road to a full recovery. I had to learn how to speak, swallow and walk because of the oxygen loss to my muscles. I went through test after test because every system in my body was affected.
Through the miracle of modern medicine, I survived with no long-term issues. After this trauma, we had to worry about what bills we would get. We had to sort out the medical procedures, doctors and specialists who worked on me while I was in the coma and whether or not they were covered by my insurance. Furthermore, when the bills showed up, we had to worry about how we were going to afford them.
Almost dying of the flu, having your entire body shut down, and having to learn how to walk again at the age of 31 is a traumatic event. Insurance companies shouldn’t compound the trauma and drag out the event by dropping a surprise bill on patients in emergency or major medical event situations.
When a patient has to see an out-of-network doctor — through no fault of their own, as is often case during an emergency or major medical event — they could receive a surprise medical bill. These bills become a surprise to patients because insurers deny payment on unexpected medical expenses even though patients pay their premiums every month and anticipate that their coverage will be there when they need it.
In Congress, both parties have agreed that it’s necessary to put an end to this practice, with urging from the White House. This represents a major opportunity to fix a problem that everyone agrees needs to be fixed. Like all things political, there are competing ideas about how to stop surprise medical bills once and for all, and not all of them are good. These ideas deserve to be debated fully, and out in the open.
But Congress might have a surprise bill of its own in the works: there’s discussion of attaching surprise medical billing legislation into a bloated, last-minute spending package that is destined to be completed in a rush so lawmakers can get out of town for the holidays.
This is unacceptable.
Congress is now considering two competing approaches to surprise medical bills. One is a fair, proven, bipartisan system that protects patients from surprise medical bills and requires doctors and insurers to resolve billing disputes through independent third-party arbitration that does not give an advantage to either party and ends the trauma for the patient.
This system is known as independent dispute resolution, modeled after a law adopted in the state of New York in 2015. The results are positive: almost 2,600 cases resolved, $400 million in cost savings for consumers, a 34 percent reduction in out-of-network bills, and insurance premiums have remained steady.
The State’s Department of Financial Services reports that consumer complaints are down substantially since the law was implemented. Texas adopted a similar law earlier this year and several other states rely on a form of IDR or arbitration to stop surprise medical bills.
The other approach working its way through Congress is known as rate setting and it might as well have been written by big insurance companies. It claims to stop surprise medical bills by allowing insurers to pay out-of-network providers the equivalent of the insurer’s median in-network rate. It is proven that rate-setting leads to narrower networks, drives providers and hospitals out of business, causes doctor shortages and makes it harder for patients to receive care when they need it.
The issue of surprise medical billing is far from resolved and it deserves to be debated fully and in the view of the public, not hidden in a Trojan Horse bill that Congress is eager to approve so they can get out of town.
Lawmakers must be accountable to patients as they consider the solution to surprise medical bills — and that means addressing the problem out in the open.
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