When a patient is rushed to the hospital in an emergency, they shouldn’t have to worry whether their insurance will cover a potentially lifesaving treatment.
Health insurance is meant to protect patients when they are at their most vulnerable. That’s why patients pay expensive premiums every month.
In 2017, a Texas high school teacher was billed more than $164,000 for stent surgery following a heart attack. His health insurance only covered $55,000, simply because the ambulance had taken him to an out-of-network hospital.
According to a recent poll, two-thirds of Americans worry about being able to afford emergency medical treatments. In fact, surprise medical bills are the most common fear among American patients.
Fortunately, Congress has a blueprint for reform. Over the last few years, many states have created systems using independent dispute resolution (IDR) system, a process where a third-party health-care expert oversees negotiations between insurers and providers.
This IDR system encourages insurers and providers to negotiate reasonable and fair rates over surprise medical bills. But most importantly, it removes patients from the middle of disputes between doctors and insurers, and protects them from being punished for emergency care. From these different states, we know that arbitration and independent dispute resolutions work.
But Congress must go further and create standards requiring insurance companies to have adequate networks for patients. Profits for major insurers have increased by $12 billion in the last five years, and the three largest insurance companies control more than 80% of the market. However, insurers continue to deny network contracts to doctors and drop physicians from existing networks.
Last month, President Trump hosted a White House ceremony where patients shared their heartbreaking stories about receiving surprise medical bills. In the following few weeks, Republicans and Democrats in both the House and Senate have released several bipartisan draft bills and discussions.
Despite the success of these IDR systems, some members of Congress are pushing for a policy that would tie payments to the median in-network rate. Although this may sound reasonable, these rate-setting proposals would only exacerbate the problem and have proven to be ineffective at the state level.
Basing payments to the median in-network rate would incentivize insurers and providers to go out of network. This would lead to doctor shortages and make it harder for patients to find the care they need.
The solution to ending surprise medical bills already exists. Congress must heed the success of these states and create an independent resolution system that removes patients from the process and lets doctors and insurers negotiate payments with health-care experts. Additionally, Congress must also create adequate network standards ensuring that providers remain in network.
Politicians in Washington may not be able to agree on much these days, but Republicans and Democrats have a golden opportunity to protect patients when they are at their most vulnerable. No patient should ever have to receive a surprise medical bill from their insurer for a treatment that saved their life.
I urge the Wyoming congressional delegation to support arbitration and independent dispute resolutions to resolve surprise medical bills and oppose the unacceptable proposal of federal rate setting.