A Practical Approach to Ending Surprise Billing

Medical bill from the hospital, concept of rising medical cost, selective focus. All data on the bill and form design are fictional, created specially for this concept.

By Reagan Knopp —

In an effort to address one of the many factors that contribute to the high cost of health care in America today, Congress is currently considering legislation that would eliminate a deceptive billing practice known as surprise medical billing. 

An issue that has affected roughly 57 percent of Americans at some point—according to a study by the University of Chicago—finding an end to surprise medical billing is something that has rare bipartisan support. The question is: how can federal lawmakers most effectively protect patients while not enacting new policies that undermine the free market, diminish access to care, and increase costs for patients?

Surprise medical billing happens after a patient receives out-of-network care. It can and does happen quite frequently in the event of unplanned, emergency care at an out-of-network ER or hospital. However, it can even happen if a patient is visiting their in-network health care center, but just so happens to receive treatment by an out-of-network provider working there. 

It doesn’t matter how it happens—the financial burdenof surprise medical bills after already having to deal with any sort of medical treatment is simply too much to place on patients already contending with excessive costs and fees as it is. So it is positive news that Congress is finally taking action on this issue. What is more worrisome is how some of their so-called solutions would purport to address this situation. 

Some legislative proposals currently being considered in both the House and Senate would call for an in-network “benchmarking” approach, which would essentially lead to government rate setting. Under this methodology, the federal government would determine and set out-of-network reimbursement rates for doctors. This is a slippery slope that true conservative members of Congress should not even be considering taking us down.

Government rate setting would in many cases mean doctors would be paid artificially lower rates than the true market value of their services as it completely disregards how providing one service or treatment in a remote, rural location can be much more difficult, time-intensive, and costly than in another setting. This take-it-or-leave-it approach would mean underpayments that add up to billions of dollars in losses, all of which could mean an increase in hospital closures or consolidations. And that means fewer choices and higher costs for patients—especially in rural parts of Oregon and the rest of the country. 

This is what happens when you meddle with the free market—a concern that some members of Congress echoed—and it’s precisely why Congress must avoid benchmarking at all costs. Fortunately, there are other legislative solutions being considered that would leverage an infinitely better approach called Independent Dispute Resolution (IDR).

IDR would bring both insurance companies and health care providers to the table to settle payment disputes, protecting patients while ensuring a fair, open, and transparent negotiation process. While a final payment rate is being determined by an independent mediator overseeing discussions, providers would be paid an interim payment representing the fair market value of the services provided, ensuring financial stability for rural hospitals and ERs. This is far and away the better option.

Keeping the government out of health care should be a priority for conservatives in Congress, and the simple fact is that a benchmarking approach to ending surprise medical billing will only further entrench Washington into our private health care system. It would also threaten access and increase costs for rural communities. Oregon’s entire congressional delegation must help ensure any legislation passed by Congress includes the free-market IDR approach to protect patients and our entire health care system.