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Supporting a patient-focused solution for surprise medical billing


The last thing anyone wants to get in the mail when recovering from a serious medical issue is an unexpected invoice for thousands of dollars. Surprise medical billing impacts millions of patients across the country, causing additional stress and hardship in an already complicated situation.

Surprise billing, however, is a major obstacle to this goal for many patients. We receive frequent complaints from patients who are outraged by unfair and unaffordable surprise bills.

A recent Kaiser Family Foundation survey found that nearly 40 percent of non-elderly adults who have health insurance have received an unexpected medical bill in the last 12 months. Another Kaiser survey found that more than three-quarters of Americans support the federal government taking action to protect patients from surprise medical bills.

Patients often receive surprise medical bills when they are still at home recovering from serious medical treatment. Health insurance is complicated and it’s easy for patients to assume their insurance company covers the cost of the care that they received, especially if it was at an in-network hospital. So, it’s a surprise when these bills arrive and patients learn care they thought was covered isn’t, creating stress and serious financial hardship for families during a difficult time. 

No one needs that kind of surprise. That’s one reason Congress should act to find a proactive solution to surprise medical billing that preserves patients’ access to quality care and protects them from surprise bills from an out-of-network provider that their insurance did not cover. 

Patients should be protected from unexpected personal out-of-network cost sharing due to gaps in health benefit plans and should have easy access to accurate and transparent information about pricing and provider networks. No one who recently received medical care should find himself or herself stuck in the middle of out-of-network billing disputes between their insurance company and health-care provider. 

Committees in the House and Senate have recently advanced legislation designed to prevent surprise medical billing. Working across the aisle, Congress should pass legislation that would hold patients harmless for out-of-network costs for unanticipated care while strengthening access to quality and maintaining affordability. 

Part of this approach includes a solution known as Independent Dispute Resolution (IDR). IDR would establish a framework for a streamlined and structured resolution to payment disputes between insurance companies and the health-care providers, removing the patient from the process. Then, both sides can submit their reasonable reimbursement offers online to be resolved through the IDR process. 

IDR is a proven solution and has worked at the state level in New York and other states. New York’s experience shows that an IDR process can work to the benefit of patients while lowering overall costs.

Since New York lawmakers passed a comprehensive surprise billing dispute system into law in 2015, transparency among insurers has increased and in-network participation and out-of-network billing has decreased dramatically, along with in-network emergency care costs. A recent report from the Governor of New York’s office estimates the law has saved patients over $400 million dollars.

IDR provides incentives for insurance companies and providers to negotiate fairly. It has made outcomes better for patients and has reduced the financial and emotional hardship caused by surprise medical bills. 

Good policy options exist for Congress to make sure that no families have their emergency savings drained to pay for a surprise medical bill. Strong bipartisan support in both Houses of Congress exists. There is no valid reason for further delay. Patients deserve to know they will no longer be subject to these unfair and unaffordable practices.

John Rother is president and CEO of the National Coalition on Healthcare.

Tags Health insurance Healthcare in the United States Healthcare reform debate in the United States Medical billing

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