Want to solve surprise medical bills? Listen to patients

Americans are fed up. Health insurance is increasingly costing more but covering less. According to a new Morning Consult poll, 59 percent of Americans say they wish their insurance company provided plans with lower deductibles so they could better afford the health care they need. Over the last 12 years deductibles in job-based health plans have nearly quadrupled. Such higher deductible plans can lead to surprise medical bills, leaving patients who suffer an emergency on the hook to pay for care out of their own pocket that they thought their insurance covered. 

An overwhelming 81 percent of Americans believe the majority of costs associated with surprise medical bills are the responsibility of insurance companies. Unfortunately, the cost of care is increasingly being pushed back on patients

Among the solutions to surprise medical bills Congress has been considering are capping rates for out-of-network providers or staying out of price-setting by providing an independent dispute resolution (IDR) process to serve as a backstop when insurers and providers are unable to resolve disagreements on payment. On the Senate side, Sen. Lamar Alexander (R-Tenn.) and the Health, Education, Labor & Pensions (HELP) Committee want to cap physician reimbursement. If enacted, the “Lower Health Care Costs Act” would allow insurers to undercompensate for services provided to patients both in- and out-of-network, straining physician and hospital resources and limiting the ability to improve clinical quality, attract top physicians and keep hospitals open. 

If the government steps in to set payment rates, it could significantly reduce the ability of local health professionals to provide timely and quality care, especially in rural communities. In fact, 63 percent of Americans are worried about the impact rate setting could have on small communities, and even more (67 percent) believe it is Congress’s responsibility to protect access to health care for the millions of Americans living in rural communities. 

Instead of such an untested approach that strongly favors insurers, Congress should look to what has already been proven to protect patients without raising costs. Recently, Reps. Raul Ruiz (D-Calif.) and Phil Roe (R-Tenn.) introduced the “Protecting People From Surprise Medical Bills Act,” which goes further than any other surprise billing legislative proposals to encourage transparency from insurance providers and make sure that patients understand the limitations of their insurance.

This legislation uses an independent resolution process to take patients out of the middle of disputes between insurers and medical providers. This efficient, market-based process has worked in a number of states, without added bureaucracy or cost. In New York, independent dispute resolution (IDR) has almost eliminated surprise bills, yet rarely even needs to be invoked, instead providing a strong incentive for both insurers and providers to set fair payments and prices from the start. As a result, insurance premiums and health care costs in the state have grown more slowly than the rest of the nation. Because it does not disrupt broader market dynamics, IDR also takes into account the increased costs associated with rural health care and ensures rural Americans’ access to health services continue to be protected. 

Health care providers and patients agree IDR is to best way to take patients out of the middle and establish a fair process to resolve differences between insurers and providers. In fact, 69 percent of Americans prefer a third-party resolution process over allowing the government to set doctors’ rates. 

For years, insurers have been manipulating the health care system to reap excess profits. And now they are using those profits to lobby Congress to interfere with the free market and increase insurers’ advantage over physicians without concern about what that could mean for patients. As Congress works to protect patients from surprise bills, it should listen to the American people and not swing the scales further in favor of the insurance industry.  

Vidor Friedman, MD, FACEP, is president of American College of Emergency Physicians.