As our nation begins to work toward a post-COVID-19 world, Congress is gearing up to debate another stimulus package. In these unprecedented circumstances, such a bill will help our country get back on its feet after months of economic lockdown and a complete strain on our health care system. However, any legislation that fails to address surprise medical billing is incomplete.
Surprise medical billing affects millions of Americans every year. In fact, 18 percent of all emergency visits and 16 percent of all in-network health care visits will result in a surprise medical bill. Not only are these statistics not acceptable for our modern health care system, but the costs associated with these bills are astounding. In 2020, the average surprise bill was over $2,000 more than what insurance would usually pay. Patients shouldn’t need to weigh the cost of an unexpected bill against their own health. In the time of COVID-19, the need for a comprehensive solution is even more heightened.
The problem arises from a breakdown in the health insurance networks used by providers. When this happens, the services that patients receive aren’t bound by in-network rates. After insurance companies have paid their share of a bill, out-of-network health care providers can bill patients for the entirety of the remaining balance. Unfortunately, those receiving these charges can also be the most vulnerable among us. And yet, even in our state-of-the-art health care system, this practice has continued for far too long. We need a strong offering of affordable and flexible health insurance plans, and we need providers in Iowa to tackle coverage in areas big and small in our state.
To understand the scope of surprise billing is to look at the entire health care system. This issue can impact all Iowans. Regardless of your health plan or employer, you could be at risk of this happening to you.
To rectify this broken practice, a market-based approach is the best solution. Using previously negotiated and median in-network rates will prevent exorbitant and unfair charges to patients. This guarantees that consumers will receive fair treatment in their billing, no matter their network relationship.
We also must ensure that any situation that puts the consumer in the middle is a solution that works for no one in our system. The baseball style arbitration that is used in the state of New York requires the consumer to pay the median price before they can even go to arbitration and sets a bad precedence in all cases going forward.
In this unapparelled time of economic uncertainty, we must address this issue head on. As Iowans leave hospitals following COVID-19 related care or for any other medical treatment, there is a good chance that several will find a surprise medical bill in their mailbox. The pandemic has exacerbated this problem, and we need a solution. Establishing a median in-network rate will let the market work for the consumer and protect patients across Iowa. Removing the patient from the middle of arbitration between insurance and health care companies will go a long way to granting peace of mind.
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These policies have plagued Iowans for long enough. In a world recovering from a pandemic, this is an important issue that deserves our attention and effort. Any effective stimulus package from Congress must include legislation to end surprise medical billing.
Marcie Strouse is government relations chair of the Iowa Association of Health Underwriters.