Mitchell: Vulnerable patients need a surprise billing fix

Mitchell: Vulnerable patients need a surprise billing fix



As a surgeon, it is my job to ensure a positive patient experience. As hard as we try to meet that goal, there are some things that are simply out of our hands -- and that includes the matter of surprise medical billing. 

As Congress gets back to work, they must continue the momentum they started toward solving this problem once and for all by passing federal legislation that permanently protects patients from surprise medical billing. More importantly, they need to do so in a balanced way that works for all parties -- patients, medical providers and health insurers.

One solution -- the Lower Health Care Costs Act introduced by Sen. Alexander of Tennessee -- would take the exact wrong approach: something called "benchmarking." A benchmarking approach to ending surprise billing would lead straight to government rate-setting, which would disrupt our entire health care system, threatening access and affordability for rural communities in particular. 

Congress should work to pass a more equitable approach that preserves the strength of our local hospitals and emergency rooms, such as the Independent Dispute Resolution (IDR) process outlined in Louisiana Sen. Bill Cassidy's STOP Surprise Medical Bills Act. IDR provides a platform for fair negotiations between insurance companies and providers by using an impartial, third-party mediator to determine payment rates based on the best "offers" submitted by both parties through a simple, online process.

While this version of IDR provides the best solution for all parties involved, there is currently legislation in the House that seeks to invoke the idea of IDR, but because it is a watered-down version, it is not nearly as effective. In the No Surprises Act, IDR and benchmarking are combined; however, the former would only kick in for cases where physician reimbursements are higher than $1,250, automatically negating over 99 percent of claims, which fall below that mark.

Both Rep. Cheney and Sen. Barrasso should work with their colleagues to support Sen. Cassidy's version of IDR and ensure it replaces the disastrous benchmarking approach in Sen. Alexander's bill. 




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