No place for surprise bills in health care

From the State Capitol

No place for surprise bills in health careBy ASSEMBLYMAN VINCE FONG

As a nation, we continue to grapple with the rising cost of health care and health insurance. This problem has only been exacerbated by the ongoing pandemic, which has not only increased the need for access to quality care, but also added financial strain to families and business owners as many states refuse to reopen their economies and get people back to work.

One important way we can improve our health care system in a real way is by ensuring no one is stuck with surprise medical bills, particularly for emergency care when patients do not have the opportunity to determine (or in many cases don’t know) whether the facility at which they are being treated is in or outside of their insurance network. Even when a patient, prior to a hospital visit, does his or her due diligence to make sure that it’s “in-network,” they can still get ridiculously high bills after their exam or procedure.

Sacramento has attempted to solve this problem through cost controls. But this approach, in practice, has proven to be short-sighted. Setting artificially low, fixed rates for providing medical care may on the surface sound like an appealing option, but it creates another problem: access.

These artificial caps could put doctors out of business. In fact, California is currently experiencing a doctor shortage, leaving many rural communities—like much of Kern County — underserved.

Conversely, there are states like New York and Texas that have found a solution to this problem through Independent Dispute Resolution. IDR establishes a process for out-of-network claims to be adjudicated by a neutral third party and most importantly, patients are kept out of the middle. Studies have shown that over the last two years, New York has decreased out-of-network costs by 34 percent. It should be our common goal to drive more solutions that are favorable to patients.

We can all agree that patients should not be stuck with surprise bills, especially in a life-threatening situation where they do not have the opportunity to check whether a particular hospital or provider is in or outside of their insurance network. By utilizing an independent resolution method that removes the patient from being caught in the middle of billing disputes between the provider and insurance, we are creating a more transparent health care system that puts patients first.

Story First Published: 2020-09-25