Op-ed: Congress Must End Surprise Medical Billing by Aimee Walsh, M.D.

Congress Must End Surprise Medical Billing

By

Aimee Walsh, M.D.

Counselor, House of Delegates

Medical Association of the State of Alabama

Past President, Alabama State Society of Anesthesiology

Past President, Mobile County Medical Society

Far too often, Mobile residents receive an unwelcome surprise in the form of an unexpected, costly medical bill. Patients who think they are covered suddenly find themselves saddled with hefty bills for lab work, x-rays, facility charges or providers’ services.

This problem is found across Alabama and much of the country—and it is within Congress’s power to fix it. But they must do so the right way.

Earlier this year, Congress began to debate legislation aimed at addressing surprise medical bills, but progress stalled this summer. When lawmakers return from their August recess, they should redouble their efforts and take action this year to ensure that no patient ever again receives a surprise medical bill.

The first step of any solution should be to take patients completely out of the equation. Payment disputes should be resolved between medical providers and insurers, without the patient being caught in the middle.

When surprise medical bills arrive, patients are often recovering from an injury or illness. They should not have their suffering compounded by out-of-pocket costs that exceed what they expected to pay for in-network coverage. In addition, surprise bills and fear of additional costs can undermine patient-physician relationships, threatening the quality of care. This core problem for patients will be eliminated if Congress prohibits sending patients surprise balance bills reflecting unexpected out-of-network costs.

With the patient removed from the payment dispute, Congress must next establish fair rules for insurers and medical providers to resolve out-of-network payment disputes. Neither side—nor should the government— be able to dictate prices, especially through the so-called “bench marking” approach, which would under compensate providers, resulting in reduced access to care for patients.

Instead, third-party data and analysis should be used to establish fair payments through a process known as Independent Dispute Resolution (IDR). IDR will be neutral, fair and cost-efficient. It will never involve patients or add further costs to them. It will also be supported by increasingly robust technology and data analysis, making the process efficient.

Any legislative solution must first and foremost establish a fair process for insurers and providers to resolve disputes without mandating fixed prices. But Congress can take additional steps as well to prevent payment disputes in the first place.

The problem of surprise bills arises in part because of changes and exclusions in health insurers’ networks. Patients may not realize that a secondary specialist—for instance, a radiologist reading an x-ray—is not part of an insurer’s network. In an emergency—where a patient is rushed to the nearest hospital and sees the first available doctor—there may be no opportunity to check coverage or travel to a more distant hospital.

It is simply wrong for emergencies to result in high-dollar, out-of-network surprise bills. Congress can also help address this issue by encouraging insurers to build and maintain robust networks.

Local U.S. Representative Bradley Byrne has made a welcome commitment to lowering healthcare costs for American families. He can help fulfill this promise by working with others in Congress to pass legislation that stops surprise medical bills—the right way.