Managing the pain
We need protection from unethical practice of surprise billing
Issuing surprise medical bills has become a lucrative business in America — and patients are left paying the price.
According to national consumer experts, “surprise bills occur when people are charged for care from outof-network providers or facilities that they receive due to no fault of their own. These bills can amount to hundreds, thousands, or even tens-of-thousands of dollars.”
A recent survey by the New Mexico Office of the Superintendent of Insurance found that “approximately 20% of privately insured respondents received a surprise medical bill . ... These rates were higher for those who had surgery, 36%, or had a visit to the emergency room, 55%.”
Everyone agrees that surprise bills are a major issue that urgently needs a solution. That’s why there is a bipartisan effort in Congress to address the issue. But some groups are trying to stop progress unless Congress agrees to pay them more.
Private equity firms on Wall Street have spent billions of dollars to buy out physician staffing companies that are the main culprits behind surprise billing and are cashing in on this unethical practice. Now, those same firms are behind a $28 million ad campaign in an effort to tank federal legislation aimed at addressing surprise billing.
Federal legislation has stalled because Congress is trying to figure out a way to make sure health care providers — doctors and hospitals — are paid a fair rate for their services. Wall Street and major medical industry lobbying groups want Congress to address surprise medical bills using something called “arbitration” or “Independent Dispute Resolution,” a process that gives them the upper hand in negotiations and leads to premium increases.
Look no further than New York, which uses arbitration to resolve surprise bills, where payments are routinely six to 10 times higher than what Medicare pays. These outrageous charges inflate premiums and incentivize providers to issue more surprise bills, since the Wall Street firms that run their staffing companies can make more money through arbitration than regular negotiations. When Wall Street is running medicine and driving up costs for patients, it’s an absolute violation of the Hippocratic oath — do no harm.
As a patient and consumer advocate, I want doctors to be paid a fair rate. But we can’t use this crisis as a way for the medical industry and out-of-state businesses to take more money out of the pockets of hard-working New Mexicans. We need a solution that fully protects consumers and doesn’t contribute to the health care cost crisis that is overwhelming family budgets year after year.
Congress should take a page from New Mexico, which recently passed legislation to ban surprise medical bills for certain types of health insurance. Under New Mexico’s law, consumers are held harmless from surprise bills, meaning they have to pay no more than they would pay at an in-network facility. When a patient is surprise billed, insurers must pay doctors a rate that is based on a standard charge in private insurance or Medicare rates with a 25% increase — whichever is higher. This guarantees that bad actors won’t use surprise billing as a way to increase their profits.
Sens. Tom Udall and Martin Heinrich have always fought hard for the best interests of the people of New Mexico. They know that New Mexicans can’t afford a $28 million ad campaign to sway the debate the way that Wall Street firms and special interests can. I urge our senators to support a solution that will fully protect patients without increasing costs on hardworking New Mexicans. Health Action NM is a nonprofit, statewide consumer advocacy organization that works to ensure that all New Mexico communities have access to quality, affordable health care.