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11.26.2019 0

Surprise medical billing should be addressed by independent neutral third party boards, not price fixing

By Robert Romano

If you have ever used an out-of-network medical provider under your health insurance, whether for an emergency or just for additional services, it is possible you have received a surprise medical billing, often costing far more than if the provider had been in-network. It can even happen if you’re at an in-network facility but the physician was out-of-network.

President Donald Trump said in May that he is committed to ending the practice.

Unfortunately, some of the solutions being pursued by House Democrats under House Speaker Nancy Pelosi (D-Calif.) and Sen. Lamar Alexander (R-Tenn.) are anything but, and instead will result in onerous government rate setting for out-of-network providers, which can do a lot more harm than good. California has a similar law.

Shant H. Garabedian, D.O., an emergency medical physician, writing for the Tennessean on Aug. 30, finds that the Alexander proposal “would establish set rates for physician reimbursement also known as benchmarking — a solution supported by the insurance lobby. His proposal would allow insurance companies to set physician payment prices by cancelling previously negotiated contracts and essentially forcing physicians into new contracts with unsustainably low rates.”

The result? More hospital closures in Tennessee (and everywhere else), which is already a major problem, making it impossible for residents to reach a hospital in time when there’s a real emergency and every minute counts. These days, physician shortages are becoming a greater problem as well, especially for rural communities.

Fortunately, there are alternatives to the Alexander approach. U.S. Rep. Phil Roe (R-Texas) has a bill that would address the issue of surprise medical billing utilizing neutral third parties, called independent dispute resolution. Sens. Bill Cassidy (R-La.) and Michael Bennet (D-Colo.) have similar legislation in the Senate.

This approach is used in states as diverse as Texas and New York, with great success and lets patients focus on their lives. In states where this is not the case, patients are often left to be the ones to resolve billing disputes by acting as a go-between for doctors and insurance companies.

A third party board would take the issue out of the hands of the insurance companies, whose goal is to have the government regulate prices, driving medical providers out of business, and create a competitive, negotiated price system.

Americans for Limited Government President Rick Manning issued a statement favoring the independent third party solution: “The problem of surprise medical billing has become a hot topic in Washington, D.C. but government rate setting is an unacceptable solution. When there’s a dispute between doctors and insurance companies, patients should not have to resolve it, which is why Congress and the Trump administration should consider an approach that institutes an independent, neutral, third party system for billing dispute resolution that will put patient needs first. That way, families can focus on their care rather than completing bureaucratic tasks just to access benefits, or worse being stuck with a surprise billing that cannot be paid.”

Manning concluded, “When New York and Texas agree on something, then perhaps it might just be a common sense, bipartisan solution that can be used to address surprise medical billing.”

Robert Romano is the Vice President of Public Policy at Americans for Limited Government.

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