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Tags: surprise | medical billing | free market | arbitration

The Best Ways to End Surprise Medical Billing

The Best Ways to End Surprise Medical Billing
(Rashad Aliyev/Dreamstime.com)

Horace Cooper By Wednesday, 09 October 2019 02:49 PM EDT Current | Bio | Archive

As Washington returns from its October break, attention is being focused on resolving the so-called “surprise billing” issue. If you’ve been to see a medical practitioner recently you probably have seen this first hand. “Surprise billing” is when you the patient receive an unexpected bill after treatment that your insurance company won’t cover.

The fees are not insubstantial. They sometimes amount to thousands of dollars. And now Washington policymakers have finally decided to deal with this issue. But the devil is in the details.

There are some who argue that this issue can be resolved by simply giving the insurance industry and government the power to set reimbursement rates. One of the most outspoken proponents of this “solution” to “surprise billing” is Loren Adler of the Brookings Institution.

Promoted as an advocate for patient access, his record is far different. Like the Bible’s admonition that we be wary of false prophets, policymakers in Washington should be very careful in examining Loren’s “surprise billing” solution.

While Mr. Loren presents himself as pro-patient, he’s consistently pushed policies that would all but destroy the private sector medical system that distinguishes the U.S. and in the process harm patient access to specialty care and undermine physician sovereignty.

Adler has publicly praised the Center for American Progress’ universal health coverage plan and he personally drafted a budget busting Obamacare expansion plan that essentially expands the Medicaid program and even includes coverage for undocumented immigrants. Like many of the 2020 Presidential competitors on the left, he advocates a “magical” wealth tax to pay for it all.

What he doesn’t explain is that any nominal savings government run or managed programs obtain typically come through rationing medical assistance. Thus, whatever complaints there are about the present hybrid of free-market and government subsidized system that serves most Americans, there is no reason to destroy it in favor of a new federal government bureaucracy.

Any resolution to the problem of “surprise billing” needs to make sure that access to quality care is maintained, that doctors can make independent judgments about patients care and that the overall costs for insurance don’t spike.

As policymakers know, the “surprise billing” amounts are not simply duplicate costs sent to patients for coverage that is already covered by their insurance. These fees represent treatment costs that are often related to out of network services a patient receives such as when he or she goes to an emergency rooms or when provided treatment from a specialist who has no pre-existing relationship with a patient’s insurance company.

A blunt price-setting mandate from Washington like Adler supports would deleteriously affect treatment options significantly. Having Washington tell a doctor or other medical practitioners what fee they will be paid will guarantee that fewer specialists will see patients out of network and likely reduce the number of specialists overall. Congress can set a fee for reimbursement but they can’t make a doctor agree to take it and reduced payments will make some specialties less attractive for doctors to pursue.

On the other hand, a directive simply telling companies to cover any fees an out of network specialist charges creates a different problem. Insurance companies will raise their premiums and/or work aggressively to limit the likelihood that you the patient ever receive treatment from exceptional specialists. Either approach means struggling households have less medical care options.

A much more prudent approach would be to build on several solutions: market-based rate benchmarks, and arbitration. Using market-based rate benchmarks, physicians and practitioners would be offered payment rates according to the “usual and customary” rates normally provided for their specialties. And when there is a dispute between the insurance company and your doctor about that rate, arbitration should be used to make sure that both the practitioner and the insurances company can come up with a payment solution that works for both.

Unlike Adler’s single sided, gift to the insurance industry approach, which will all but destroy the village in order to save it, with some creativity, Washington can end “surprise billing” while ensuring patients get access to specialists, don’t face higher premiums, and rewarding doctors are for the quality care they provide.

Horace Cooper is a writer and legal commentator. Previously a visiting assistant professor of law at George Mason University School of Law, his research focus was on U.S. intellectual property rights policy, the role of the United States Supreme Court in the American constitutional system, political forecasting, the legislative process, and federal labor law. Mr. Cooper has also served in senior capacities in the George W. Bush Administration including at the Voice of America and in the Department of Labor under then Secretary Elaine Chao, and on Capitol Hill as Counsel to former Majority Leader Richard K. Armey. To read more of his reports — Click Here Now.

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As Washington returns from its October break, attention is being focused on resolving the so-called “surprise billing” issue.
surprise, medical billing, free market, arbitration
Wednesday, 09 October 2019 02:49 PM
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