Surprise Medical Billing

Surprise Medical Billing

October 29, 2020

Even before COVID, 1 in 5 Americans were receiving a surprise medical bill after seeking emergency room care.  That can cripple the financial stability of a family, and it’s clear Congress needs to find a solution that will protect access to quality healthcare while safeguarding patients.

Unfortunately, the new “compromise” legislation being considered in Congress now is really no compromise at all. It rewards big insurance at the expense of local doctors and hospitals who were on a financial knife edge even before the pandemic. 

The legislation would require billing disputes between insurers and providers over “out of network” care to enter arbitration. That sounds good. But arbitrators would be forced to first consider existing “medium in-network rates” over all other relevant factors when making judgments. That’s just government rate setting by another name! This provision would also create an incentive for insurers to drive down their in-network rates and shrink their provider networks to maximize profits.

Transferring the financial risk of surprise medical billing from patients to both hospitals and doctors is not a compromise or a solution. It would make it harder, if not impossible, for providers to receive fair payment for the care they deliver and keep patients stuck in the middle of the process.

Rosa Mora

Miami, FL

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