Every year, millions of American receive a medical bill they never anticipated. This practice, called surprise medical billing, is unfortunately an industry standard and affects patients across the country. The financial strain from these bills is devastating in a time when many can scarcely afford health care at all. Surprise medical billing also hurts doctors, who don’t receive fair reimbursement pay for their medical services as a result of the practice.
While there is a movement in both the Congress in Washington and the Legislature in Lansing to end the practice, not all proposals to end surprise medical billing are equal. Some, such as insurance backed rate-setting, give insurance companies too much power. The right solution to end surprise medical billing is Independent Dispute Resolution.
IDR is a proven method for ending surprise medical billing. It establishes a mediation process between providers and insurers via a third-party mediator. Patients are removed from the billing dispute and no longer receive surprise medical bills. IDR proposals such as Sen. Bill Cassidy’s Stop Surprise Medical Bills Act have garnered significant bipartisan support.
The bill has over 30 bipartisan co-sponsors in the Senate and has all the right provisions, including a clause that guarantees an interim reimbursement payment while provider-insurer negotiations are ongoing. IDR has a proven track record in places like New York and Texas, where it has allowed for both doctors and providers to reach a fair agreement on reimbursement rates. Patients are always kept out of the middle.
The other proposal to end surprise medical billing is government backed rate-setting. Rate-setting allows insurance companies to set their own rates of out-of-network reimbursement pay to doctors. Health insurers prioritize their bottom line, so under a rate-setting law they would naturally pick the lowest possible rate. Some proposals include a 20 percent cut in reimbursement which would put many providers, rural ones in particular, in the red.
While IDR has strong bipartisan support, rate-setting has strong bipartisan opposition. Democratic leadership has called the No Surprises Act a “giveaway to insurance companies.”
Major health trade associations such as the American Medical Association and the American Hospital Association have also voiced their opposition against the bill. Rate-setting would lead to practice closures across the nation.
In a time where COVID-19 is ongoing and many doctors are facing a financial crisis, rate-setting will only compound the issues facing the medical community. It must be opposed in any form, and I hope Sen. Gary Peters recognizes this is not only good policy but also good politics.
Surprise medical billing has existed long before COVID-19, it has continued to persist during the pandemic. With increasing health care costs across the board, patients can scarcely afford unforeseen, high-cost medical bills. While there seems to a genuine interest to end surprise medical billing, we cannot end it on the terms set forth by health insurance lobbyists.
Rate-setting would allow big insurance companies to low-ball doctors across the board. This could end up being the straw that breaks the camel’s back, putting tens of thousands of frontline health care providers out of work.
The right proposal to end surprise medical billing is clear. Independent Dispute Resolution levels the playing field between doctors and insurers while protecting patients from surprise bills. The independent arbitration process is the only way to truly solve billing disputes without harming the consumer.
Rami Khoury, M.D., is the immediate past president of the Michigan College of Emergency Physicians.
Rami Khoury, MD, FACEP
Regional VP
IEP-PC
Office: (517) 205-4938/ Ext 4938
Cell: (248) 259-1329
Fax: (517) 205-6410
Email: rkhoury@iep-pc.com