Here’s a reasonable solution to surprise medical bills


As a cancer survivor, I know how devastating it can be to get hit with high, unexpected medical bills — especially when they trigger never-ending fights with insurance companies. The absolute last thing that patients recovering from major illnesses, surgeries, or procedures should have to worry about is facing more financial burdens when they should be only focused on their recovery.

That’s why it is well past time for Congress to address the issue of surprise medical billing. The good news is that there are several legislative proposals in both chambers of Congress seeking to do exactly that. But lawmakers must be careful to avoid certain measures that would only create more problems than they solve.

One especially dangerous proposal is known as “benchmarking,” which would essentially put the government in control of setting out-of-network rates for physicians. However, by setting these rates arbitrarily low, a benchmarking approach to ending surprise medical billing would slash payments to providers. These losses would be shifted to local hospitals and emergency rooms, undermining their ability to provide quality care.

In Louisiana’s hard-to-reach, rural communities — and traditionally underserved urban ones– it’s already hard enough to get access to a doctor and to pay the bill.  By creating new financial burdens, a benchmarking “solution” could force many of the health care facilities serving these communities to lay off staff, pare down the services and treatments they offer, or even close down altogether. Reducing access to those who need health care the most is not a good solution — in fact, it is not a solution at all.

Fortunately, a far more effective, less disruptive option exists in the form of legislation that seeks to address the surprise billing issue through a process called Independent Dispute Resolution (IDR). The IDR process would create a level playing field for insurers and providers to negotiate out-of-network payments in good faith.

Essentially, the entire process would take place online, with each party submitting their most reasonable payment “offer” through an online portal. An unbiased, third-party mediator would determine a final payment amount based on these offers as well as a number of other factors and independent data. This balanced approach ensures payments are fair and based on the true market value of the services rendered. 

Moreover, IDR would allow for interim payments to providers at the beginning of the process, which is especially important to help keep struggling urban or rural health care facilities financially strong and secure. That way, at-risk patients will not see their ability to see a doctor or pay for services to be compromised or undermined in any way.

Not only does IDR represent a fairer, more reasonable approach for all parties involved, but it is the only solution currently before Congress that has been proven to work. In New York, where an IDR-focused solution for surprise billing became law in 2015, out-of-network billing and emergency care costs have decreased by 34 and 9 percent, respectively. IDR has helped save New Yorkers more than $400 million in emergency services alone.

I am proud and grateful that that one of my home state senators, Louisiana Sen. Bill Cassidy has introduced the STOP Surprise Medical Bills Act, which includes the all-important IDR framework. Louisiana Rep. Steve Scalise, as a member of leadership, should work to oppose benchmarking in any House legislation and ensure the proven IDR approach is a central part of any bill the House, or Congress, ultimately passes. 

While I was fortunate enough to be able to navigate the complicated surprise-billing process that arose after my cancer treatments, not all Louisiana patients are so lucky. IDR would help protect them from ever having to worry about being hit by a surprise bill in the first place.

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Stuart H. Smith is an attorney based in New Orleans fighting major oil companies and other polluters.
Cooper Law Firm

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