John Knappmann: We need real solutions for surprise medical billing

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Michiganders need relief when it comes to surprise medical billing. 

Fortunately, Congress finally seems to be taking action as it inches toward a legislative solution. As they do so, our elected officials in Washington must ensure the final bill they pass on this matter does not result in any negative, unintended consequences for patients.

As an attorney, I’ve seen that this problem happens far too often. Patients receive treatment, thinking their costs will be covered by their insurance plan, only to be caught off-guard weeks after the fact when a bill arrives in the mail demanding payment. It can happen when a patient is treated at an out-of-network hospital or emergency room — or it can even happen at an in-network facility if the physician or specialist providing care is not in that same network. 

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Either way, it creates new hardships for patients and their families.

Sadly, some of the solutions in Congress could only make things worse for patients, creating new obstacles to care and driving up prices — especially in our many rural communities. One such solution calls for a federally mandated benchmark approach to setting rates paid to out-of-network physicians. While this may technically shield some patients from surprise medical billing, it would actually end up hurting more patients than it helps.

Allowing the government to dictate rates would ignore the drastically different levels of complexity and cost associated with providing clinical services in various parts of the country and among different kinds of health care centers. By doing so, many providers could end up being underpaid for their services, shifting enormous financial losses onto local hospitals and emergency rooms. 

For the facilities serving rural Michigan, this could be especially devastating as many are barely eking by as it is. If these health care centers are forced to close down — or scale back their services and staff — it would have a dramatic impact on rural Michiganders’ ability to access the care they need at reasonable costs. We need a better, less invasive solution to end surprise billing.

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Luckily, there is another, bipartisan path under consideration in Congress — it’s called Independent Dispute Resolution (IDR). Under an IDR model, patients would be protected from surprise billing and both insurance companies and health care providers would be empowered to negotiate payments on an individual basis, preventing a one-size-fits-all approach that quite frankly wouldn’t work for settling out-of-network payments. 

IDR establishes a transparent negotiation process through which payment disputes would be settled by a third-party mediator. Until a final payment is set, insurers would pay providers temporary payments in order to ensure financial security for struggling hospitals and emergency rooms.

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This is the only solution in Congress that has been proven to work. In New York, state lawmakers implemented an IDR process to protect in-state patients from surprise billing back in 2015. Since then, network participation has grown while out-of-network rates have continued to shrink. Moreover, the process has increased transparency for insurers and helped keep emergency care costs stable. It is a model of success that Congress should seek to replicate on a national scale.

It is well past time for Congress to end the burden that surprise medical billing places on the backs of vulnerable patients here in Michigan and across the country. U.S. Sens. Debbie Stabenow (D-Lansing) and Gary Peters (D-Bloomfield Twp.) — as well as the rest of Michigan’s congressional delegation — should throw their full support behind IDR as the method for protecting patients from surprise billing and help make sure it is included in any legislation Congress ultimately passes on this issue. 

Michigan patients and their families, especially in often-neglected rural areas, will be all the better for it.


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