Who Foots the Surprise Bill?

As U.S. Senators prepare for a July vote on proposed legislation that would protect patients from surprise medical bills, three key players in the health industry are gearing up for battle: doctors, hospitals, and insurers.

Each group has pledged to protect patients from unexpected medical bills, which generally result from treatment by out-of-network doctors at in-network hospitals. Who should assume the added costs associated with this protection, however, remains up for debate.

Doctors and hospitals are lining up in favor of using independent arbitrators to determine the appropriate provider payment rate, removing patients from any disputes. A 2015 New York state law has reduced thousands of out-of-network bills using a binding arbitration process.

“I’m a big believer that the states experiment and we learn from their experiment,” said Sen. Bill Cassidy (R-LA), who supports the approach used in New York.

Insurers, on the other hand, want Congress to set reimbursement rates. Industry trade group America’s Health Insurance Plans (AHIP) urged lawmakers to “avoid the use of complex, costly, and opaque arbitration processes that can keep consumers in the middle and lead to higher premiums” in a March letter to Congressional leaders.

The issue of surprise medical bills received bipartisan scorn at an April 2 House subcommittee hearing, and the White House has recently taken action by sharing a list of principles it hopes will be used as the basis for a legislative solution.

As a senior administration official described the situation, “Providers point fingers at payers, payers point fingers at providers, and the American people are left really getting the shaft.”

Source: The Hill, May 11, 2019.