Opinion: End surprise medical billing

Rich Studley

The cost of health care has become increasingly burdensome for households and businesses across Michigan and our country. And the practice of surprise medical billing makes matters worse, hitting patients with unexpected costs. Congress must take meaningful action to end this practice. 

Employers are often on the front lines of having to help their employees understand their insurance bills and why they may have received a bill for $100, $500 or several thousands of dollars from an out-of-network health care provider practicing at an in-network facility. 

The employer is often the one explaining to their employee why they must pay a surprise medical bill, even though the patient was never told the network status of the provider or given an estimated cost for procedure.

Employers, like employees, have seen the financial ruin these billing practices can create. And they, too, are frustrated and left wondering why there is a lack of oversight and protection under state or federal law.  

To be clear, the issue of surprise medical billing comes from a small but significant section of the provider community. Clinical specialists who fail to qualify or choose not to participate in health plan networks are not subjected to the same pricing rules as those who participate in a network. It is these specialists who can bill whatever they choose for their services — and without fear of consequence. 

Ideally, the free market would settle these problems. If health care and health insurance were a free market, prices for health care goods and services would be set freely between patients and health care providers. But that is not the reality of our system today. 

The price of these services is not negotiated by the patient; thus patients are blind-sided by these billing practices. In emergency situations, there's no time to ask good questions about other options and out-of-pocket costs associated with procedures. Even in non-emergency situations, patients often lack the necessary tools to explore their options.  

The Lower Health Care Costs Act of 2019 will tackle the root cause of surprise medical billing by implementing market-based benchmark rates and forego implementing needless arbitration procedures, Studley says.

To protect patients, consumers and businesses alike, Michigan’s congressional delegation should support fair, market-based benchmark rates for out-of-network medical services. Once in place, these benchmarks will create safeguards that protect patients by ensuring predictable costs for medical services, so patients don’t have to choose between paying medical bills and providing basic necessities for their families. 

Unfortunately, some in Congress have suggested an arbitration dispute process as a solution to the problem of surprise billing. But this lengthy process could ultimately raise premiums for businesses and patients by encouraging providers to set the highest price possible for medical services in preparation for the negotiation process. Health care costs are already on the rise, and inserting a costly, drawn-out mediation process would only make matters worse. 

Legislation in the U.S. Senate would create fair market rates for non-network providers. The Lower Health Care Costs Act of 2019 will tackle the root cause of surprise medical billing by implementing market-based benchmark rates and forgo implementing needless arbitration procedures. Because the cost of any service, particularly health care services, should be reflective of a competitive, market rate and should not be ultimately dictated by any third-party mediator.

It is time for Congress to act in a way that protects consumers and saves businesses from needless added costs. 

Rich Studley is president and CEO of the Michigan Chamber of Commerce.