Congress has the opportunity to pass a bipartisan solution to permanently end surprise medical bills.
Surprise medical billing occurs when a patient sees a doctor that is “out-of-network”—even at “in-network” hospitals. Surprise bills often run in the thousands of dollars and arrive months after service. Under Sen. Alexander’s plan, Americans will no longer receive a surprise medical bill, ever—end of story.
Congress has the rare opportunity to pass significant health care legislation with bipartisan support. President Donald Trump and the administration have already outlawed surprise medical bills for COVID-19 patients. If it’s the right thing to do for COVID-19 patients, it’s the right thing to do for all patients.
Americans make 137 million emergency room visits each year, with 1 in 5 visits to the ER resulting in a surprise medical bill. Unfortunately, medical bills are the No. 1 cause of bankruptcy for U.S. families.
According to the Kaiser Family Foundation, about 5 percent of physicians refuse to go in-network. These doctors tend to be specialty physicians, including many emergency room doctors, anesthesiologists, radiologists, and pathologists who have a financial incentive to game the system. It’s shameful to think that 5 percent of doctors want to continue to heap outrageous bills on the backs of unsuspecting patients.
It’s worth noting that insurance plans typically cover patients’ out-of-network costs—they just don’t pay as much toward the claims as they would if a physician was in-network. Insurance companies aren’t the ones balance billing patients—it’s the physicians trying to capture extra profit.
Patients must have some assurance that all treatment received at an in-network hospital will be billed and paid at a rate that is compatible with fair median market rates commonly accepted for the same procedures by in-network physicians.
The only real opposition to ending surprise medical bills are those doctors and private equity firms that benefit from excessive out-of-network bills. In the last few years, private equity firms have bought up physician staffing companies and then forced their doctors to stay out-of-network so they can bill sky-high prices.
If no solution is enacted, private-equity-backed medical staffing companies will continue abusing patients. The hospital-based physicians treating these patients know full well that patients are going to a hospital that is in their network, with little to no knowledge that some of their treating physicians may be out-of-network. The practice is deceptive at best and unethical at worst.
The harsh reality is that patients usually have no choice in the matter, because it’s basically doctor roulette in the emergency room with whatever doctor happens to be on-call at the time.
The Lower Health Care Costs Act’s median pricing benchmark is the only free-market solution that is fair to both patients and doctors, and it’s the only solution that actually stops surprise medical billing. Doctors refusing to go in-network would receive the median in-network rate for their local area. Opponents falsely argue this is a government-set rate when in reality it’s actually a dynamic price that automatically goes up or down depending upon real-time market prices.
Arbitration, another proposed solution, is bad policy because it still allows surprise billing to occur and involves expensive attorneys in a costly drawn-out process on a case-by-case basis. A government-set rate is also a bad idea as it’s anti-competitive, anti-free-market, and gets government even more in the businesses of health care and controlling prices.
Congress should pass the Lower Health Care Costs Act now to help bring certainty to patients and enact meaningful free-market-based health care reform.