For patients, trying to figure out how much a visit to the hospital is going to cost these days feels like it might be best suited for a Ouija board. For medical providers, the growing outcry against surprise medical billing should be a call to arms to make sure their voices are heard as legislation works its way through state capitols and Congress.
Physician groups and healthcare organizations are ramping up their lobbying efforts to make sure lawmakers understand their side of this dynamic and the unintended consequences that could result from legislative efforts that do not take all sides of the equation into consideration.
There are no winners in the public relations battle about surprise medical bills. Hospitals and doctors who are not in a patient’s insurance network look callous and uncaring for charging more than what other carriers, like Medicaid, charge for similar procedures. There are reports of patients who conduct painstaking research to try and determine what their medical bills will be, only to find out they were significantly more than what had been estimated. And that’s not even the worst cases, where individuals in emergency situations receive bills for tens or hundreds of thousands of dollars when they leave the hospital.
A number of states, along with Congress, are considering legislation that would cap the amount that a patient would have to pay in a surprise medical billing situation. Polls reveal that most Americans believe that individuals should not be liable for a bill from an inadvertent out-of-network provider. Doctors and hospitals are being blamed, but this situation is not their fault, either.
The downside to a solution that lawmakers are considering to reduce the amount of surprise medical bills would actually offer incentives to insurance carriers to cancel contracts with doctors, leaving hospitals with no in-network specialists. For example, in California, which enacted a law capping surprise medical bills, nine hospitals have no anesthesiologists that are part of an insurance program for health plans in those areas.
Medical providers need to make sure that lawmakers see the unintended consequences that could result from surprise medical bill laws. Doctors who are not part of an insurance carrier’s program would be bound to the terms of contracts they did not sign.
Everyone appears content to place the blame for balance billing at the feet of doctors and healthcare organizations, but their shoulders should not be where all of the blame is placed.
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