Congress should pass Lamar Alexander’s surprise medical bill proposal
- Mae Beavers is a former Tennessee state senator, state representative and Wilson County commissioner.
Tennessee just set some unfortunate new records. In the past few days, the Volunteer State saw record-high numbers of COVID-19 cases and deaths. More than 2,000 Tennesseans are currently hospitalized with the coronavirus.
More people than ever are visiting emergency rooms and health clinics, and COVID-19 rates are booming in the state’s rural areas. That’s usually the perfect recipe for financially devastating surprise medical bills.
Surprise billing occurs when insured patients receive unexpected – or unexpectedly expensive – bills from out-of-network hospitals or health care providers.
Luckily, Congress and the Trump administration have instituted policies to prevent Americans from being bilked by excessive charges for coronavirus testing and treatment. Now it’s time similar protections are provided to all patients, no matter their illness or injury.
Patients can be charged ‘a fortune’ in surprise bills
Surprise bills often come after patients are taken to hospitals outside of their insurance network. The ambulance, the hospital and doctors can potentially all be billed as out-of-network, leading to massively inflated prices.
Exorbitant bills can even pop up when patients are treated in an in-network facility, and by in-network doctors, but receive additional services from clinicians, such as assistants, anesthesiologists and pathologists, who don’t participate in the patient’s insurance network.
A study published in the Journal of the American Medical Association found that 20 percent of Americans who undergo elective surgery — or surgery that they schedule in advance — incur unexpected out-of-network medical bills. And that can cost patients a fortune.
According to the health policy journal Health Affairs, assistant surgeons charge out-of-network patients an average of 2,652% more than the established Medicare payment rates. On average, anesthesiologists bill out-of-network patients eight times more than Medicare patients, and pathologists increase their charges nearly five-fold.
Yale researchers estimate that surprise medical bills unnecessarily cost Americans with employee-sponsored health insurance $40 billion annually.
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In addition to being a costly burden on patients who are forced to pay surprise bills out of their own pockets, these excessive charges levied by some out-of-network health care practitioners raise the cost of insurance for everyone.
Why some congressional proposals will not work
A study published in the American Journal of Managed Care found that eliminating the ability to surprise bill would save every insured American an estimated $212 a year.
Members of Congress have floated legislation to address the problem, but many of the proposals have failed to gain traction because they don’t go far enough, or offer solutions that do little to fix the problem.
For example, a bill in Congress to adopt a system of arbitration to address surprise billing would increase costs, reduce the number of in-network…
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