The issue of surprise medical billing has become an increasingly important issue for our lawmakers in Washington, but that wouldn’t surprise many patients in South Carolina who already understand its ramifications and have experienced the overall shortcomings of the U.S. health care reimbursement system.
Shedding light on this pervasive problem should inherently be a good thing; however, the factors at the root of the problem are often misconstrued in the public debate. As an emergency physician in South Carolina, I have seen first-hand the primary driver of surprise medical bills — the systematic shifting of costs from insurers to patients as a means to reduce health plan premium costs.
This development can be traced to insurers offering what they call “skinny” health plans with higher deductibles and fewer in-network doctors. This offers patients a lower monthly premium but leaves them financially exposed in an emergency. As a result, more than two-thirds of Americans are delaying or avoiding medical care because they are worried about receiving a surprise medical bill.
Making matters worse, insurance companies have increasingly pushed costs on to patients and doctors while continuing to reap billions in profit and failing to adequately reinvest in the health care system. This causes financial hardship to patients who cannot afford care and emergency medical providers whose resources are limited by a lack of insurance reimbursements.
In short, the emergency departments that serve as the safety net of our health care system and see patients at all hours every day, regardless of their insurance coverage, are being pushed to the brink because the funding necessary to sustain them is in jeopardy. South Carolinians deserve better.
We all agree that friends and loved ones recovering from illnesses or emergency procedures should not have to worry about getting stuck in the middle of a billing dispute between their health care providers and insurance plans. Many physician organizations, including my own, have petitioned state legislatures and Congress to address surprise medical billing. Several states have recently passed surprise medical billing legislation, including widely effective efforts in New York and, most recently, Texas. However, because of the nature of federally regulated, employer-funded insurance coverage, a comprehensive federal solution is needed.
That is why we are asking Congress to pass comprehensive legislation to achieve this goal. Among the bills in Congress, H.R. 3502 has the opportunity to do this. The legislation recognizes the balance necessary to simultaneously protect patients from the effects of surprise medical billing while not undermining limited available funding needed to preserve a fragile emergency medical delivery system, which is the fundamental shortcoming of several other bills under consideration in the U.S. House and Senate.
Included in this patient friendly solution to surprise medical billing is a vital element called Independent Dispute Resolution. IDR would ensure patients are kept out of billing disputes while putting in place a fair, open and transparent process for insurers and providers that brings both sides to the table to negotiate payments overseen by an independent mediator. It is the very same process that has worked in New York and Texas to protect patients while increasing network participation and controlling costs.
Furthermore, IDR encourages arms-length negotiations between the two parties, which will in turn promote sufficient in-network reimbursement. Sufficient reimbursement means that emergency departments across the country can continue to provide the efficient, high-quality care that we all deserve when we need it the most.
As a frontline emergency physician, I am asking our South Carolina congressional delegation to help ensure that the legislation Congress ultimately passes to address the issue of surprise medical billing uses the proven IDR process, which will put patients first and hold insurers accountable.
R. Preston Wendell, M.D., MBA, is regional medical director at TeamHealth.