Finding a path forward to end surprise medical billing
By U.S. Senator Bill Cassidy, M.D.
July 19, 2019
The stories of Americans affected by surprise medical bills are hard to believe. A teacher with insurance was taken to an out-of-network medical facility when he suffered a heart attack and was charged $108,951 out-of-pocket for his care. A college student was charged $17,850 for a urine test after her back surgery. She too had health insurance and was given no reason to suspect that this routine request from her doctor would lead to a massive charge from an out-of-network lab.
Our Senate bipartisan working group first proposed using an independent dispute resolution process as a backstop to protect patients in our STOP Surprise Medical Bills Act, which has the support of 27 bipartisan senators. Having an independent dispute resolution process creates a safety valve for when the formula used to calculate compensation amounts is wrong and a backstop to prevent parties from exploiting the formula to manipulate rates.
This week, our colleagues on the House Energy and Commerce Committee took an important step forward by passing a bill to address surprise medical bills that includes an independent dispute resolution process similar to the process in our STOP Surprise Medical Bills Act.
The current Senate bill that passed the Senate Health, Education, Labor, and Pensions (HELP) Committee, unfortunately, takes a different approach. The HELP Committee version uses a benchmark to decide payments. While our legislation suggests this mechanism as well, it also includes an IDR process. The HELP Committee version, however, is missing this critical safety valve, an omission that may lead to some serious issues down the road.
Without some independent dispute resolution process, there is little incentive for the big insurance companies to negotiate with doctors and hospitals, risking patient access to care. This is especially true for rural hospitals, which have little power to negotiate in the first place and that, in some cases must pay doctors more to attract them to their rural communities.
to protect patients from surprise medical bills, providers, hospitals, and insurers will have to put the patients first. The government should not be picking winners and losers. Health care providers and insurance companies have both benefitted from our current system. But to fix it, we need to ensure both are held accountable.
We are committed to helping the patient. This process isn’t over and we are thankful for that. HELP Committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) have continued to engage with us as we work to incorporate additional feedback in the committee’s bill before it reaches the Senate floor.
We look forward to continue working with the committee, and with our colleagues on both sides of the aisle in the House and Senate, to make sure we succeed in this effort.
Read the full oped here.