As a public servant and the chairman of the Utah Legislature Social Services Appropriations Committee, I’ve been focused over the past two years on finding ways to reduce the costs of health care.
I’ve tackled the high price of drugs by going after the middleman, by passing state laws, and requesting federal action. Along those same lines, Congress has an opportunity to get unfair medical costs under control — by addressing surprise medical billing.
Surprise medical billing is a too-common occurrence that happens after a patient receives care at either an out-of-network facility — frequently, when receiving unplanned emergency care — or from an out-of-network physician working at an hospital or other health care setting that actually is in the patient’s network.
The latter scenario is becoming more and more common as insurance companies continue to shrink their provider networks, leaving gaps in coverage that often take patients by surprise. Weeks after receiving treatment, patients are slapped with often-excessive bills for the cost of care not covered by their insurance plans.
Everyone involved — doctors, patients, insurers, and policymakers — all agree that patients should not be forced into the middle of these kinds of billing disputes.
Some of the legislative solutions that have been introduced would attempt to end surprise medical billing by simply handing over the responsibility of determining payment rates for physicians performing out-of-network care to the federal government. This approach is reckless at best, and at worst a disaster in the making.
Through an ill-advised process known as benchmarking, some in Congress would have the government essentially set rates for doctors across the country. Anyone who has been engaged in the health care discussion can see the error in this methodology. Health care does not lend itself to a one-size-fits-all approach, and neither does determining rates doctors are paid.
Benchmarking also gives an inordinate amount of power to insurance companies, both in the billing dispute process and over what kind of care patients can receive. We need a better solution.
Fortunately for Utah and the rest of the country, Congress is also considering legislation that would take an entirely different — and far more responsible — approach by implementing an independent dispute resolution (IDR).
Think of IDR in terms of Major League Baseball. It is essentially the same process by which players and teams resolve salary disputes. It has also been proven to work in health care to shield patients from surprise medical billing. In New York, which passed a state law leveraging IDR for that exact purpose in 2015, it has helped boost in-network participation, increase transparency among insurers, and decrease out-of-network rates and bills — all while keeping emergency care costs stable.
Congress has all the tools it needs to pass strong legislation to prevent surprise medical billing while protecting patient access to quality, affordable care. It only needs to put the pieces of the puzzle together.
As they continue to negotiate a solution, it is my sincere hope that Utah’s entire congressional delegation get behind the proven IDR process and make certain that any bill Congress ultimately passes to resolve this issue includes it instead of the potentially devastating, anti-free market benchmarking approach that some still seem to be pushing. Utah patients, physicians, and communities are counting on it.