OPINION: Let’s pass ‘Protecting People from Surprise Medical Bills Act’

A recent poll from the American College of Emergency Physicians confirmed what many in the medical community already know: a majority of Americans want insurance companies to take more responsibility when it comes to surprise billing.

In fact, 89 percent of respondents said they believe insurance companies should pay for surprise medical bills rather than hospitals, doctors or patients. While insurers and providers may have different opinions on how to address surprise medical bills, one thing both parties can agree on is that it’s time to remove patients from the middle of these disputes.

Dr. Eric Van Moorlehem

After all, contracts are between insurance companies and healthcare providers, not patients who, understandably, expect their health insurance to cover the bulk of their costs. Instead, insurers continue to shift greater financial responsibility onto patients, leaving them with bills they don’t expect and can’t afford.

A recent report from TransUnion Healthcare exposed a dramatic rise in out-of-pocket expenses. The study found that 59 percent of patients had an average out-of-pocket responsibility between $501 and $1,000 for a medical visit in 2018, up significantly from 39 percent in 2017.

In addition to facing financial hardship, the fear of these unanticipated out-of-pocket costs is causing patients to put their health at risk. As a practicing emergency physician in Scottsdale, I’m seeing more patients, particularly older adults, raise concerns about being admitted to the hospital because they don’t know if their insurance will pay for their care.

While we encourage patients to be informed and active participants in their care, physicians never want them to make potentially life-threatening decisions for themselves or a loved one out of fear of large out of pocket costs due to their insurance plan benefit design. When a patient comes into the Emergency Department, my only thought is to provide the best possible care – and that patient’s only concern should be getting better, not how much they’ll have to pay.

In 1986, Congress passed the Emergency Medical Treatment & Active Labor Act (EMTALA), which ensures public access to emergency services regardless of a patient’s insurance coverage or ability to pay. In an emergency, the health and safety of patients is the No. 1 priority.

Earlier this year, Arizona joined a growing number of states that have enacted laws to protect patients from surprise bills – particularly when they are treated by out-of-network providers in an emergency. However, more can be done at a federal level to protect patients.

The Protecting People from Surprise Medical Bills Act, which is being discussed on Capitol Hill, would create a national standard to remove patients from the middle of those disputes completely. Introduced by Rep. Raul Ruiz, M.D. (D-CA), and Rep. Phil Roe, M.D. (R-TN), the draft legislation uses an independent dispute resolution (IDR) process and now has more than 40 cosponsors.

The solution closely follows New York’s model, which has been proven to protect patients’ access to quality, affordable care. Recent experience in New York and Texas demonstrates that an IDR process brings health plans and providers toward more in-network arrangements. It has not led to increased premiums and does not create additional administrative burden.

It is a process which has been successful in helping to contain costs.If Congress approves the insurer-backed rate setting solution, instead of an IDR, I fear that there will be grave impacts on patient care, the nation’s physician shortage and care in our rural communities as well as hospital closures.

Healthcare impacts us all, and we all share a responsibility to make it better, not worse. As physicians, we’re doing our part to provide high-quality care and be in-network with as many insurers as possible.

It’s now Congress’ turn to do the right thing for patients.

Dr. Eric Van Moorlehem is a practicing emergency physician in Scottsdale and SVP at Envision Healthcare, a national hospital-based physician group.

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