No more surprises

Doctors and patients put in a bind

You’ve probably seen the headlines in Arkansas lately. Insurance companies are pushing around patients and forcing them to pay bills they can’t afford. Even worse, many of these patients never saw these bills coming.

This month alone, a huge insurance company tried to slash the reimbursement rates for doctors that take care of the sickest babies at one of the state’s largest health-care facilities. When doctors pushed back on the insurance company reducing its payment rates by 50 percent, the insurance company retaliated by terminating the contract. This termination cut these vitally important doctors from their network, and more importantly cut access to in-network coverage for these patients and their families.

So what happens to families that have received care since the contract cut? They will likely end up getting a denial letter in the mail from the insurance carrier and an out-of-network bill to cover this expensive treatment.

Unfortunately, these families are not alone. Every year, millions of Americans and tens of thousands of Arkansans receive expensive medical bills. These bills are difficult enough to deal with if they’re expected, and even more difficult when they are unexpected. These unexpected bills, otherwise known as surprise medical bills, financially strain thousands of people.

We need to take the necessary protective steps to remove surprise medical bills from the health-care system. In order to do so, we must develop a bipartisan solution that protects doctors and consumers from predatory insurance practices, like the example we’ve seen in Arkansas just this month. This bipartisan solution is Independent Dispute Resolution (IDR).

Thirty percent of patients covered in private health plans have reported receiving a surprise medical bill after receiving treatment, and even patients covered by employer plans can receive surprise bills. Insurance companies send these payment requests after a patient visits an out-ofnetwork provider and, even worse, it doesn’t matter if they originally sought care in-network; any part of the patient’s treatment that is deemed out-of-network is dealt with via surprise medical bills.

As you can imagine, the effects of this can be disastrous. Twenty percent of insured Americans are struggling to pay their medical costs, and patients with outstanding medical debt are likely to skip out on any future treatment for fear of receiving more unexpected medical bills they cannot afford.

So, what is the solution? We’ve seen what happens in Arkansas when insurance carriers have too much control; they cut off access to in-network care at the expense of patients and their providers. As we speak, the insurance companies are lobbying Congress to let them set their own reimbursement rates to out-of-network providers. As for doctors and health-care facilities, if they don’t give in to an insurance company’s demands, they get kicked out of the network and could be forced to close their doors.

Instead of giving more money to the insurance lobby, we need to support Independent Dispute Resolution. This solution involves setting up an arbitration system that’s similar to what Major League Baseball uses to negotiate salary disputes.

IDR would put an independent mediator in between doctors and insurers. The mediator would oversee any billing disputes as a fair and independent third party, and doctors would get their fair share of reimbursement.

The most important aspect of IDR is that patients would no longer receive these surprise medical bills. Through the mediator, doctors and insurers would work out disputes over reimbursement without sending a surprise bill to the patient.

IDR is a bipartisan solution to surprise medical bills. Senators Maggie Hassan, D-N.H., and Bill Cassidy, R-La., have put forth the STOP Surprise Medical Bills Act. Their proposal establishes IDR as a system to make medical costs more transparent. Under the STOP act, patients seeking emergency services only have to pay the in-network rate for their treatment. Even for non-emergency services, if the patient receives outof-network treatment at an in-network facility, they’d still only pay the in-network rate. The STOP act also makes sure that providers are paid a reimbursement sum.

This is a true bipartisan solution that protects both patients and doctors. I call on Senators John Boozman and Tom Cotton to support this important legislation that will protect patients, help providers, and keep the insurance companies from gaining more control over our health care.

Every Arkansan deserves an equal opportunity to health care. Surprise medical bills threaten this opportunity by forcing people to choose between financial or medical well-being. We can’t let the insurance companies give themselves any more negotiating power.

We have to make sure that the interests of patients and doctors are at the forefront, and Independent Dispute Resolution is the best solution to ensure we do that.