Williamson Herald: Commentary: Alexander has right answer to resolve surprise medical billing

From the Williamson Herald
 By Gregg Lawrence

In the midst of the current health-care crisis there is a step that Congress should take to have an immediate positive impact and reassure patients seeking care that they will not be stuck with a surprise medical bill that could bankrupt their family.

With the potential of an increasing volume of patients at hospitals and other health-care providers over the next few months, many patients have an increased risk of seeing an out-of-network doctor, even at an in-network hospital.

The stats are staggering. Currently, one in five patients this year will receive a surprise medical bill. Most will receive the bill from a hospital that is in their insurance network. The reason is that about 5% of physicians tend to stay out of network in order to charge sky-high prices. These doctors exploiting the system are typically emergency room doctors, anesthesiologists, radiologists and pathologists.

Private equity firms that own physician staffing companies know they can game the system by keeping their doctors out of network, even at in-network hospitals, and reap the massive profits off the backs of unsuspecting families. These families reasonably believe that all the providers they see at their in-network hospital will be billed at in-network prices with corresponding in-network copays.

Yale researchers Zach Cooper and Fiona Scott Morton found that out-of-network physicians charge an average of 798% of what they receive for a Medicare patient, while in-network physicians are paid at 297% of Medicare.

It is essential during this health-care crisis that patients have the peace of mind from knowing that if they are at an in-network hospital, they will not be hit with a surprise medical bill months after their visit. Any visit to an in-network hospital should result in billing that is compatible with the median community rates commonly accepted for the same procedures by in-network physicians.

It’s important to note that in-network rates are often two to three times the Medicare payment rate and in-network doctors have been operating profitably on these payments for years. So, the argument that doctors will be forced out of business is simply not defendable.

Sen. Lamar Alexander’s proposed legislation protects patients from surprise medical bills while also ensuring a fair and free market. Opponents of his solution to surprise medical billing falsely argue that this is a government-set rate. This is a red herring, and nothing could be further from the truth. 

The important thing is that Alexander’s solution takes the patient out of the middle. Private equity firms last year spent $53 million and counting to oppose Alexander’s bill in order to protect their obscene billing practices.

Congress should do the right thing by passing Alexander’s legislation, which would put an end to surprise medical billing while also implementing a median pricing free market-based solution. Hopefully Senate Majority Leader Mitch McConnell will put Alexander’s bill to a vote.