"Surprise billing" in health care don’t reward the villain – Bucks County Courier Times

By Dr. Marion Mass| Bucks County Courier Times

Here are six dots to remember. Well connect them later.

Now, lets connect the dots with a scenario a dangerous, nasty emergency.

A drunk driver hits your child. Femur: broken. Fracture: compound. Blood: abundant.

Your child is rushed to the nearest emergency room.

Compassion, a professional oath, and the EMTALA all demand that the hospital spring into action.

Someone will take your insurance card; but at that moment, nobody (especially you) cares about insurance networks.

Maybe the hospital is in the network. Maybe the ER physician who examines your child, the radiologist who reads the x-ray, the anesthesiologist who puts your child under, and the orthopedic surgeon who sets the bone and closes the wound… maybe all, some, or none are in the network and must accept the insurers payment.

In any case, you expect your insurer to cover the emergency treatment and to pay the people who saved your child the professionals whose role is to render such service.

Instead, because the insurer follows the Golden Rule He who has the gold makes the rules the following may be your experience.

You may receive surprising bills from parties involved in your childs treatment who were outside the network. You may think that youre being gouged, but think again.

Astounded at your insurers denial of payment, you may go back and forth with your insurer and with those who sent the bills. You will be up to your neck in the fine print of your policy.

You will be disgusted and probably very worried.

And you, not the insurer, may end up on the hook for those surprise bills.

Can you spot the villain?

Given the forces at work in the health care industry, surprise billing has become so commonplace that its now on the radar of lawmakers in Washington.

They have two solutions in front of them. Both would prevent you, the patient, from receiving surprise bills.

One is benchmarking. It favors insurance companies by leaving them with the ability to game the system, while guaranteeing that the shrinkage in the nations supply of physicians will continue, and that there will be deepening problems with access to in network physicians. California uses benchmarking. At best, the data on the programs success is limited and ambiguous. You can check.

The other is independent dispute resolution (IDR) the approach adopted in New York and Texas. IDR requires that the surprise biller and insurer go through binding, independent arbitration. Physicians prefer it because it evens the playing field in their struggle against insurers for survival and helps those who actually treat patients to stay in practice. Seems to work well. You can check.

Despite the availability of a pure IDR bill that has 110 bipartisan co-sponsors, a House committee has sneaked a benchmarking solution with three co-sponsors into a bigger bill. They must think people are stupid and not paying attention.

What can you do?

Contact your representatives in Congress.

Tell them to become informed on the subject.

Tell them not to reward the insurance industry. (The villains in this scenario are definitely not fighting for their survival.)

Tell your representatives not to make the spectacularly stupid choice that will continue to choke the life out of the medical profession.

Tell them to make the smart choice: IDR.

Marion Mass, M.D. is aBucks County pediatrician; co-founder ofPracticing Physicians of America and amember of this papers editorial board.

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"Surprise billing" in health care don't reward the villain - Bucks County Courier Times