Independent dispute resolution process offers best fix for balance billing

There are few healthcare policy issues as pressing as finding a solution for out-of-network, or “surprising billing,” of patients. Physicians take an oath to provide the best possible care we can—but that’s not possible when our patients are afraid of getting a surprise bill for medical costs they thought would be covered by their insurance.

Over the past 12 years insurance companies have been steadily increasing their deductibles—leaving patients on the hook for upwards of thousands of dollars before coverage even starts. In addition, insurers have sold plans without sufficient in-network care providers, also called “narrow networks.” Narrow networks, combined with high deductibles, are most often the cause of surprise medical bills.

Throughout discussions, physicians have been steadfast in their commitment to taking patients out of the middle in a thoughtful way that ensures access to care.

Successful legislation must protect patients, first and foremost. If a patient receives unanticipated out-of-network care at an in-network facility, they should only be responsible for in-network cost-sharing. This protection should apply to copays, coinsurance, and deductibles.

Patients benefit most when physicians are in-network with as many insurers as possible. Physicians are concerned legislation that encourages “rate-setting” will give insurers extra leverage to push even more providers out-of-network and profit further by shifting additional costs to patients.

An independent dispute resolution process, or IDR, however, solves the problem of surprise medical bills related to out-of-network care without disrupting the broader market, and without having to involve patients at all. IDR is a proven market-based approach that brings everyone to the table, making it an efficient and easy way for insurers and physicians to negotiate fairly and quickly, without added bureaucracy or costs.

The solution put forth by Reps. Raul Ruiz (D-Calif.) and Phil Roe (R-Tenn.), both physicians, the Protecting People from Surprise Medical Bills Act (HR 3502), would establish robust patient protections including a workable IDR. The bill currently has more support than any other pending surprise bill legislation in the House of Representatives. IDR has been used successfully in New York state, where surprise bills have been greatly reduced and the number of in-network physicians has increased, all while saving significant healthcare dollars.

Insurance can be made more patient-friendly, too. Insurance companies should be more transparent about the limits of their coverage by detailing information on everyone’s insurance card about the deductible, which can easily range into the thousands of dollars, rather than just copays, which are often less than $50. They should also make up-to-date directories of in-network providers more readily available and easier to understand.

Physician societies representing more than 300,000 physicians across multiple specialties are united in support of finding a legislative solution to solve surprise bills without impacting patient access to care. Congress is working hard to identify one, and physicians are hopeful it can be done so that patients can focus on their health needs when seeking medical care, rather than worrying about their insurance coverage.

https://www.modernhealthcare.com/opinion-editorial/independent-dispute-resolution-process-offers-best-fix-balance-billing