Insurers Shouldn’t Be the Only Voice in Debate over Surprise Billing Fix
Doctors and other health care providers have voiced their strong support for legislation that ends surprise medical billing.
You might not know that from reading recent media reports. Big insurance companies and their allies in Congress have been adamant that there is only one way to fix surprise billing – their way. But their proposal is a Trojan Horse that will decimate many local hospitals and threaten the availability of emergency care – particularly in rural and underserved areas.
Surprise medical bills happen when patients receive unexpected out-of-network care and then receive a bill after the fact because their insurer failed to cover the cost. This can often happen in emergency care, when patients experiencing a medical emergency do not have the opportunity to research whether the closest hospital is part of their insurance network, or the insurer has failed to update their list of participating providers.
TeamHealth has a longstanding policy against surprise billing. Even though insurers frequently ask us to pass costs onto patients, we do not surprise bill. Less than five percent of care delivered by our 9,000 clinicians across the country is out-of-network. When care is out-of-network, it is often the result of insurers unilaterally canceling network agreements.
Now, as Congress advances surprise billing legislation, big insurers are attempting to strong-arm legislation that gives them more power and allows them to increase their already record-setting profits. Their approach will significantly hurt patients’ ability to see a doctor and would put many doctors and hospitals out of business.
Both patients and their doctors deserve to be part of the conversation about how to stop surprise billing while making sure patients can still access medical care when they need it. To that end, TeamHealth has joined Doctor Patient Unity, a coalition representing tens of thousands of doctors across the country who understand the importance of preserving access to life saving medical care.
Through Doctor Patient Unity, we are advancing a solution that prohibits surprise billing, limits patient responsibility for in-network co-pays and deductibles and removes patients from billing disputes by creating an independent dispute resolution (IDR) system. Such a system allows providers and insurers to reach fair reimbursement through an arbitration-style process.
This is similar to legislation already in place in states like Texas and New York. As shown by a recent study released from New York regulators, it has been proven to protect patients from surprise bills without giving outsized leverage to either party. In contrast, the rate setting plan pushed by insurers has already been put into place in California. The state’s surprise billing law has been ‘utilized as a weapon’ in contract negotiations and insurers are incentivized to cancel contracts, offer ‘take it or leave it’ negotiations at unsustainable rates, and further reduce the size of their networks. That’s why the California Medical Association and the 43,000 physicians it represents has voiced grave concern over insurer-backed proposals in Congress, like Sen. Lamar Alexander’s “Lower Health Care Costs Act.”
Make no mistake – insurers are sponsoring surprise billing legislation in Congress to drive down out-of-network rates by having the government benchmark them to the insurer’s own in-network reimbursement level (so-called “government rate setting”). In turn, this incents each insurance company to drive down its own median in-network rate simply by terminating providers paid above the median. This will directly lead to an immediate and precipitous drop in physician reimbursement rates.
That’s not just a problem for doctors and hospitals, it will have devasting consequences for patients too. The insurers’ proposal threatens our country’s medical safety net. Emergency room doctors have a professional and legal obligation to treat every patient they see, regardless of ability to pay, putting them at a negotiating disadvantage with insurers that don’t have to worry about network adequacy in the emergency department. However, between uninsured, Medicare, and Medicaid patients, three out of every four emergency room visits are reimbursed below the cost of providing care.
Commercial insurance reimbursement is the only way emergency departments can afford to keep their doors open. Giving insurers the ability to drastically reduce reimbursement would shred that social safety net. Reduced reimbursement is a major reason why an increasing number of rural hospitals are already facing dire financial situations.
We understand that insurers will try to distract from this fact by attacking provider groups like TeamHealth, our investors, and our efforts to advance a solution that works for everyone, not just insurers. They have spent tens of millions of dollars lobbying, funded think tanks, and advanced academic studies that falsely blame providers like TeamHealth for surprise bills, even though we maintain a policy against such a practice.
The American public and our elected leaders in Congress deserve to hear a fair debate, and TeamHealth and other doctor groups will continue to be a part of it. We refuse to cower to the big insurance companies who all too often put their profits before the best interests of our patients. It’s time to stop surprise medical bills with a proven solution that protects patients and preserves their access to live-saving medical care.
Leif M. Murphy is the President & CEO of TeamHealth