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Opinion: Surprise medical bills make your wallet sick

Roger Kahn

One of the first things you learn in medical school is the Hippocratic oath: “Do no harm.” It’s that time-honored code of physicians around the world that guides us in the practice of medicine. As physicians, we make the best determinations and treatment plans for our patients to help them lead happier, healthier, more productive lives.

When you get sick and need to see the doctor or have a medical emergency requiring a visit to the hospital, the last thing on your mind should be if you’re going to be stuck with an exorbitant bill you can’t afford.

Every year, millions of Americans are stuck with hundreds of thousands of dollars in unanticipated medical expenses not covered by insurance companies, Kahn writes.

That’s why surprise medical bills pose such a danger to health and wellness. Every year, millions of Americans are stuck with hundreds of thousands of dollars in unanticipated medical expenses not covered by insurance companies. In fact, these surprise medical bills are the leading cause of bankruptcy and discourage Americans from seeking the medical care they need.

There’s a common-sense way to fix this crisis, but right now profit-seeking insurance companies are pushing a plan which would only make matters worse and threaten patients’ financial security and their relationship with their doctors. Health insurers are already limiting which doctors and procedures are covered as “in-network” and a lack of transparency of what is covered and what isn’t leaves patients on the hook for health care they think is covered.

The insurance industry is aggressively lobbying Congress to mandate that insurers only pay a reduced rate to hospitals and doctors, compromising care and access to those patients who need treatment the most. If big insurance companies are successful in their lobbying effort, it could cause rural, small emergency rooms here in Michigan to close their doors as they aren’t able to cover the costs of treating patients. As a physician, I know this would have a serious impact on heath care for those who need it most, threatening life-saving treatment for those who do not have the ability to choose among many health facilities.

There’s a better solution, and Congress needs to step in and take leadership so that billing disputes don’t result in patients being left out in the cold with astronomical medical bills.

A process called independent dispute resolution (IDR) is a fair and equitable, bipartisan, solution which ensures that any billing disagreements between insurance companies and health care providers is adjudicated by an objective third-party expert mediator who is able to determine the fair-market value for doctor visits and procedures.

This takes patients out of the middle and prevents waking up one day finding that after a visit to the doctor or hospital, they are now under a mountain of crushing medical bills leaving them in financial ruin. It will also lead to greater transparency from big health insurance companies of which doctors and facilities are covered, and guarantee that patients in rural communities have an adequate number of specialist physicians and emergency room doctors to treat them.

We’ve seen IDR work in other states. For example, following New York’s passage of independent dispute resolution legislation, out-of-network billing has dropped by more than 33%, consumers have been saved more than $400 million, and patient complaints of medical bills dropped dramatically.

It’s time to stop passing the buck along to patients for life-saving medical treatment. The insurance industry-driven proposal of lower payments and sticking the burden onto doctors and patients isn’t sustainable. The only equitable approach to these payment disputes is an independent, objective, fair-minded mediator between insurance companies and medical providers to determine how much insurance companies may charge and also how much providers accept. Congress needs to take a page from physician’s book and “do no harm” by putting the care of patients first, not sticking them with staggering surprise medical bills. Independent dispute resolution accomplishes this by safeguarding patients, ensuring robust access to medical care, and demanding greater transparency from insurance companies.

Roger Kahn, M.D., is a former Michigan state senator.