The column below reflects the views of the author, and these opinions are neither endorsed nor supported by WisOpinion.com.
Here in Wisconsin and across the country, more than 4 million Americans have been diagnosed with COVID-19. Doctors, nurses and other frontline healthcare providers continue to heroically risk their lives to treat this deadly pandemic. Despite the national crisis, large health insurance companies continue to send surprise medical bills to patients.
As an occupational therapist in Wisconsin for almost 20 years, I have worked with patients in many different settings from inpatient rehabilitation to home health care and pediatrics. In all of these varied environments, there have always been patients who believe that their health insurance covers their procedures only to later find out that they were denied coverage. Patients shouldn’t have to pay expensive insurance premiums every month just to find out they owe more money for the treatment they need.
These “surprise medical bills” occur when insurance companies refuse to cover the full cost of care or when insurers raise out-of-pocket costs like co-pays and deductibles. A study from 2018 found that more than 50 percent of American adults have received a surprise medical bill that they thought was covered by their health insurance company. It is wrong for insurance companies to send surprise bills to patients and it is time for Congress to fix this problem.
There is a right way and a wrong way to address the issue of surprise medical bills. Senator Lamar Alexander (R-LA) and Senator Patty Murray (D-WA) want to give insurance companies the power to set reimbursement rates that hospitals and doctors depend on. Large insurers already use their market power to lower re-imbursements, kicking doctors and providers out-of-network if they do not accept. Giving them more power would be disastrous for hospitals and providers.
This rate-setting approach would impose a 20 percent pay cut on frontline medical providers in the middle of a pandemic. This is why Senator Alexander and Murray’s No Surprises Act has been opposed by doctor and hospital groups like the American Medical Association, American Hospital Association, and the Federation of American Hospitals. More than 160 economists also oppose rate-setting, noting that, “such proposals represent a direct government intervention in health care that would hurt access to care, especially for patients in rural areas.”
A rate-setting law has already been tried in California. It failed to address the root causes of surprise billing and just gave more power to insurers to lower re-imbursements that medical providers depend on. If passed, Senator Alexander’s legislation would shut the doors of hospitals, clinics and other healthcare facilities across Wisconsin-especially in rural and underserved communities. Rate-setting was misguided before COVID-19, it would be disastrous now.
Thankfully, there is a better approach to solve surprise medical billing. Senator Bill Cassidy’s (R-LA) Stop Surprise Medical Bills Act protects patients and providers, not big health insurance companies by mediating disputes through an independent dispute resolution mechanism (IDR). IDR has succeeded in both New York and Texas because it brings providers and insurers together to determine a fair reimbursement for a medical procedure or treatment. Patients are kept entirely out of the middle and are held financially harmless.
Senator Cassidy’s bill has more than 30 bipartisan cosponsors in the Senate, while a similar bill in the House introduced by Representatives Phil Roe and Raul Ruiz has more than 110 bipartisan co-sponsors.
I urge Wisconsin Senators Ron Johnson (R) and Tammy Baldwin (D) to co-sponsor the bi-partisan Stop Surprise Medical Bills Act. It’s the right bill to solve the issue of surprise bills because it protects patients and doctors, not big health insurance companies.
–Boyington is president of the Wisconsin Occupational Therapy Association