It is an uneasy scenario for any Louisiana resident. Imagine you are heading to a hospital for medical care. Since you are heading right to the hospital, that probably means it is for an emergency. A team of doctors, nurses, and support staff check you in, figure out what’s wrong, and deliver the time-sensitive treatment you need; as they do, you’re thankful that you have health insurance which covers emergency treatment.
Unfortunately, when you open your mailbox a few weeks later, you discover an outrageous bill for some aspect of your hospital visit, such as the charges for the emergency room doctor or the anesthesiologist. This bill is not for a co-pay, or payment against your deductible, but the full price tag of that service. It could be thousands of dollars in charges for health care services that you were sure would be covered.
This situation is what is called surprise medical billing. For more than one year, our U.S. Senator Bill Cassidy has been working tirelessly to generate support among his colleagues to stop it. Not surprisingly, the insurance industry is fighting back. Their high-priced lobbyists are targeting Senator Cassidy to weaken his bill, known as the STOP Surprise Medical Billing Act.
Surprise medical bills are most often the result of a billing dispute between insurance companies and the doctors and hospitals who deliver treatment. In theory, these disagreements should not negatively impact the patient, but the reality is quite different as too many people are getting stuck with exorbitant bills.
When insurers refuse to cover an out-of-network provider, patients get caught in the middle. This is one of the problems addressed by Senator Cassidy’s STOP Surprise Billing Act. It would remove patients from the dispute completely. Due to this benefit and many others, Cassidy has recruited 30 bipartisan sponsors for his legislation.
In fact, Senator Cassidy is spearheading the effort to end these surprise attacks on our pocketbooks by adopting Independent Dispute Resolution (IDR), which encourages all parties to come together for arbitration. Hopefully, insurers and healthcare providers will come to an agreement; however, if they cannot resolve the dispute themselves it gets decided through an independent mediator. Everyone gets fair treatment.
This commonsense approach is being opposed by insurance companies, which are funneling millions of dollars into lobbying efforts. Their self-serving goal is to create a system that benefits them, and their leading proponent is Senator Lamar Alexander (R-TN). He is pressuring our Senator Cassidy to abandon IDR for a system of reimbursement that favors rates set by the insurance company.
Their favored approach is known as “benchmarking.” It sets reimbursement rates for out-of-network providers to in-network reimbursement rates. It also grants complete negotiating leverage to insurance companies.
Under this plan, emboldened insurers would have the ability to drive down reimbursement rates and put enormous financial strain on doctors and hospitals. Rural and urban health care providers, who do not have enough resources to make up for the lost revenue, would become particularly vulnerable.
If enacted, Senator Alexander’s plan would threaten countless doctors and hospitals with the risk of financial ruin. In addition, at the time when Americans need healthcare the most, hospitals may be forced to close and salaries for critical care workers may be cut as much as 20 percent or more. Most importantly, it will lead to less access to healthcare for patients.
Amid a pandemic, Alexander’s plan is not a solution. Instead, it will make our current crisis much worse.
We must encourage Senator Cassidy to hold firm to his current legislation, which has a companion bill in the House. His approach is the best for patients, healthcare providers, and insurers. It is time we solved the problem which is negatively impacting so many people in Louisiana.
IDR is the “fix” forward to protect patients from surprise medical bills while keeping secure the health access and affordability our families need. Please tell Senator and Dr. Bill Cassidy to stand by his bill, which ends surprise medical billing the right way.