Congress Must End Surprise Billing the Right Way

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by Stewart Burkhalter

Surprise medical billing is a longstanding problem that contributes the rising costs of care patients face in our health care system. Momentum to address this issue seems to be building in Congress, but federal legislators must ensure that whatever solution they enact does not inadvertently threaten access to care or increase costs even further for Alabama workers.

The Trouble with Benchmarking

Unfortunately, a particularly misguided proposal that would implement a “benchmarking” approach to solving this problem would do just that. Under benchmarking, the U.S. government would set out-of-network rates for physicians using insurance companies’ own biased data and in-network averages as a guide.

By using these highly discounted in-network rates as a basis for out-of-network ones, benchmarking would:

  • Slash reimbursements for physicians performing out-of-network care.
  • Pass tremendous financial losses onto local hospitals and emergency rooms, many of which are already struggling.
  • Make it harder for these facilities to continue providing high-quality, comprehensive health care for Alabama communities, particularly rural ones.
  • Lead to fewer choices and higher prices for patients as rural health care facilities are forced to cut back services, consolidate, or close down for good.

By unfairly skewing an already distorted marketplace, benchmarking poses a serious threat to rural, blue-collar communities here in Alabama and across the country. Congress must find a better approach.

Ensuring Fairness through Dispute Resolution

Fortunately, there is a far more effective solution that has been outlined in other legislative proposals under consideration in Congress. Known as Independent Dispute Resolution (IDR), this process would enable medical providers and health care insurers to settle out-of-network payment disputes between themselves.

Not only would IDR shield patients from the entire process, but it would help ensure payments are fair and accurately reflect the cost of care by providing a neutral negotiation process. Here’s how it would work:

  • Providers and insurers would submit their best offers for payment through an online portal.
  • A third-party mediator would review these offers as well as a number of factors and independent data to determine a final payment amount.
  • Until that time, initial payments to providers would help keep at-risk hospitals and emergency rooms serving Alabama’s hardworking rural communities strong and secure.

What it all boils down to is fairness. IDR is a balanced, reasonable approach that ensures neither “side”—nor the U.S. government—is dictating prices for the other. Instead, the two parties are able to reach a middle ground through open, transparent negotiations, much like the compromises that the labor and business communities reach to advance solutions that work for both parties.

Time for Congress to Act

Now is the best opportunity for Congress to move forward with a true, IDR-focused solution to end surprise medical billing once and for all. Representative Terri Sewell and the rest of Alabama’s congressional delegation should work to ensure that whatever bill Congress passes includes the equitable IDR framework.

Alabama’s workers and rural communities are counting on a fair, balanced approach to protect patients and preserve access to care. IDR offers just such an approach.