Profits come from denials

ACCORDING TO Axios, the not-for-profit Health Care Service Corporation — parent company of the BCBS (Blue Cross Blue Shield) plans in Illinois, Montana, New Mexico, Oklahoma and Texas — received a $454 million tax refund for the first half of the year, bringing its net profits in 2019 to more than $2.3 billion. The previous year was just as good for the company, bringing in $4.1 billion for the year. In addition, this year, it is required to return $323 million of unpaid rebates to consumers who were overcharged.

These profits are generated in part by the routine denial of coverage. We especially see this with emergency air medical services, deeming these emergency services not “medically necessary” despite the fact that air ambulances are deployed only by a trained first responder or doctor. Some insurers have gone even further by refusing to bring this lifesaving service in-network. Shifting the cost of emergency services to patients allows insurers to continue to rake in massive profits while leaving their members left to foot the unpaid bill.

Lawmakers should keep these practices in mind as they work to address surprise billing. Proposed legislation — Section 105 of S. 1895 — would allow insurers to pay providers a benchmark rate, essentially allowing insurance companies to set their own prices. Benchmark rates will put additional strain on air medical providers and the patients who rely on their service.

Rather than giving insurers all the authority to determine what they will cover or how much they will reimburse, federal legislators should be focused on directing HCSC and all insurers to either cover health benefits — particularly emergency services — or lower overall health care premiums. Congress should oppose setting arbitrary benchmark rates that will contribute to even bigger profits for insurance companies and do nothing to address surprise billing.

CARTER JOHNSON Spokeswoman, SOAR (Save Our Air Medical Resources) Campaign Washington, D.C.