Opinion Pieces

By Congressman Rick W. Allen (GA-12)
March 1, 2020
https://bit.ly/2vnzYAJ

We never know when an accident or medical emergency will happen, but we do know that when you receive care you’ll likely receive a bill in the mail. But too often, properly insured patients go to a hospital or other health care provider and end up with costly, unexpected charges. To reduce or eliminate that surprise medical bill, patients are typically burdened with countless phone calls and piles of paperwork.

This issue is increasingly affecting Americans all across the country. A new study conducted by Stanford University researchers found that patients who visited the emergency department in 2010 had a 32% likelihood of receiving a surprise medical bill. In 2016, the likelihood increased to 43%.

Fortunately, both Republicans and Democrats can agree we need a legislative fix, and President Trump has made the ending of surprise medical billing a priority for his administration.

While I’m thrilled there is an appetite in Congress to actually get something done, some of the legislation I’ve seen would set reimbursement benchmarks. This model is similar to government rate-setting we see in socialist countries. Any proposal that uses this model would lead to premium increases, overall higher out-of-pocket costs and a decrease in patient choice.

I’m proud to serve on the House Education and Labor Committee, where we recently held a markup of House Resolution 5800 – the Ban Surprise Billing Act. After extensive conversations with physicians throughout Georgia’s 12th District, the consensus was that patients should be removed from the middle of this burdensome process, but H.R. 5800 was not the solution.

The Medical Association of Georgia agrees.

“H.R. 5800 is bad legislation that clearly favors the insurance industry,” said the Medical Association of Georgia. “It uses an inadequate and oversimplified median in-network rate as the basis for physician pay, and arbitration would only be an option when claims exceed $750 – which isn’t much of an option since most claims are less than that. Making matters worse is that arbitrators couldn’t even consider other billed charges under this measure. H.R. 5800 would place physicians at a significant disadvantage, which will ultimately mean that patients have less access to care.”

That’s why I am a cosponsor of the Protecting People from Surprise Medical Bills Act, bipartisan legislation introduced by members of Congress with backgrounds in the medical profession. This bill uses an arbitration model similar to the one successfully adopted by New York state and Texas.

With this model, patients are held harmless for unexpected costs incurred from emergency care or care they received with the reasonable belief that it was received while in-network. If out-of-network providers and insurers cannot agree on the payment rate, they must enter into an independent dispute resolution process, or IDR. During this process, insurers and providers submit an estimate of the cost for the patient’s care to an arbiter who decides the fairest price – creating an incentive for both parties to choose reasonable numbers.

The good news is there are several proposals currently in Congress to address surprise medical billing, and I’m hopeful we can negotiate a deal that ends this harmful practice, increases transparency and prioritizes patient access to care.

I will continue fighting for working families and medical providers across Georgia’s 12th District who have suffered from costly, unexpected medical bills and government overreach. We must end surprise medical billing now.