My View: Close loophole on surprise medical bills
Back in March, President Trump held a news conference on health care reform in hopes of promoting legislation on surprise medical billing. Drew Calver of Austin, Texas, was in attendance and took the stage to explain how he suffered a heart attack and took an ambulance to the nearest hospital.
The hospital, which he did not have a role in choosing, was not covered under his insurance provider's network, leaving him with an out-of-pocket medical bill of $110,000.
Congress, in light of patient testimonies such as Calver's, is beginning to move toward a solution to these types of situations.
The STOP Surprise Medical Bills Act, recently introduced by Sens. Bill Cassidy, R-La., and Tom Carper, D-Del., closes the surprise medical bill loophole by making insurance companies automatically pay doctors and hospitals the difference between the patient's in-network co-pay and the median in-network rate for physician services, removing the patient from the process entirely.
The highlight of the STOP Surprise Medical Bills Act is that it allows insurance providers the opportunity to appeal this payment to doctors and hospitals through a third-party arbitrator. Working directly with the insurance companies and hospitals, the arbitrator would make a final payment decision based on the industry average rates for the patient's specific geographic area.
A recent Georgetown University study on similar arbitration legislation passed in New York found a "dramatic" decline in complaints, and that insurance providers make a concerted effort to sort out their payment disputes prior to filing with an independent arbitrator.
Other legislators, including our own Rep. Greg Walden, also are working on solutions. Walden introduced legislation that takes a slightly different approach, in which insurance providers would be forced to pay a standard rate based on the median cost in their area.
The problem with this approach is that it relies on insurance industry-controlled median contracted rates for out-of-network services, thus insurance providers would no longer have an incentive to negotiate a lower rate with hospitals and doctors.
Congress should act swiftly to alleviate the undue financial burden put on Americans by surprise medical bills. Thus far, no better solution has been presented than the STOP Surprise Medical Bills Act, where the billing loophole is closed, while also implementing an arbitration mechanism on behalf of the patient.
Dr. Chuck Goldberg is a primary care physician in Portland.
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