Healthcare

Congress should seek a real solution to surprise medical billing

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Like many average Americans, health care and its costs are a significant issue.

Imagine you have what is considered “good” health insurance coverage. Now you find yourself at the emergency room and you receive care which includes services by emergency room staff and supporting doctors. You have provided your insurance information and eventually leave believing you are covered. Sometime months later, you receive a bill for services not covered by your insurance.

In another scenario, you have to undergo a recommended procedure shortly before you go in for scheduled surgery. You receive a call indicating your insurance will not cover the recommended procedure and you must provide payment for the process to go forward.

These unsettling situations are happening frequently to many citizens, and Congress is finally stepping up to try and address the problem of surprise medical billing. There are several proposals being considered, and some offer hope while others are very concerning.

Sens. Patty Murray and Lamar Alexander submitted a joint proposal on the subject last year, as did Sen. Bill Cassidy. As you might imagine, this set the stage for a showdown between health care providers, hospitals and the insurance industry. The complexity of this issue leaves all parties with some responsibility, but for us in Maine, you might want to consider a few points.

If the Murray/Alexander proposal, which focuses on what’s called “rate setting,” is adopted, it would be bad news for rural communities and health care providers. The rates would likely be set at levels that many doctors, especially doctors in specialty fields, will not be able to accept.

This would also amount to a giveaway for insurance companies. The rates set in statute could be greater than the rates patients would pay in a free and fair market. To provide remedy for consumers receiving surprise medical bills, elected officials should pursue solutions that are less disruptive to the market.

The proposal by Sen. Cassidy seems to favor patients more as it would provide for an arbitration system, known as independent dispute resolution, to negotiate between insurers and health care providers, giving the patient someone in their corner and acting as a backstop to surprise medical billing.

Pursuing a proposal that includes rate setting without an IDR process would be a mistake. Without an IDR there would be little incentive for insurance companies to negotiate with hospitals, particularly rural hospitals in states like Maine that do not have much pull at the negotiating table and might have to pay doctors more to retain their services in the community.

The IDR would not give either side too much power in negotiations, but would rather create a neutral common grown for billing disputes to be resolved. Neither providers, hospitals or insurers get the upper hand, which is why it serves as a reasonable compromise for all parties involved.

Some states like New York have already established legislation that appears to be working in this area and we hope Congress what look to their examples.

For those of us who live in what is the oldest state in the nation, the effects from this legislation can be significant.  Maine Sen. Susan Collins should continue her work monitoring this legislation and do what is best for Maine citizens. 

About Jim Hamper

Senator James Hamper is currently serving his fourth term in the Maine State Senate. He serves the people of Senate District 19, which includes Bridgton, Harrison, Naples, Sebago, Brownfield, Denmark, Fryeburg, Hiram, Norway, Otisfield, Oxford, Paris and Porter.

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