One of the worst days of any person’s life is having to be rushed to the emergency room. Pain, stress, anxiety are all part of the visit. What can quickly make this crisis worse is the arrival of a surprise medical bill because they unknowingly sought care outside of their insurance company’s network. The good news is that there is a bipartisan solution gaining momentum in Congress based on legislation we passed here, right in our own backyard: The STOP Surprise Medical Bills Act.
Studies show that one in four Americans will be hit with a surprise bill. Here’s how this happens.
Most patients — particularly those in emergency room situations — never think to ask if a hospital or their doctor are both in their insurance network. Who would? Others are in no shape to ask anything. Their priority is getting better, not running physicians through an eligibility questionnaire.
In fact, one recent national patient survey showed that nearly three-quarters of patients who received surprise bills had no idea that the provider who cared for them was out-of-network when they were being treated. Hardly a surprise.
Out-of-network care is, by definition, priced differently than care from providers in your health insurance network. When the time comes to settle the costs, patients sometimes get stuck in the middle and left on the hook for the balance remaining after their insurance covers only what the plan would normally pay to an in-network provider. The problem is that with more and more insurers narrowing their networks, doctors are finding themselves outside of them despite often doing everything they can to be in-network. What can be done?
The good news is that this year the Colorado legislature passed a state measure to address surprise billing, and Gov. Polis signed it. While Coloradans now have new protections, it’s time for Congress to act and pass the only proven solution so all patients — no matter where they live — don’t have to worry about being caught off guard by a surprise medical bill.
Our home state Sen. Michael Bennet is the lead Democrat sponsor of the STOP Surprise Medical Bills Act, which is modeled on the only tried and tested way to end surprise medical billing: Independent Dispute Resolution (IDR). First implemented in New York State in 2015, this IDR process — similar to the arbitration process used for Major League Baseball players — protects patients from having to negotiate with providers and insurance companies while promoting access to quality care. It also greatly increases transparency in the medical billing process which, as any patient will tell you, is long overdue.
IDR works. That’s why there has been a groundswell of support in the states, from right here in the Rockies to New York to Texas. Patients win and both providers and insurers have a reliable and predictable structure to settle out-of-network claims. We hope that Congress and the White House seize this rare moment of consensus and bring reform to surprise billing this year. Literally millions of Americans will applaud an end to this stressful, expensive and needless burden that succeeds only in compounding the pain that comes with a health-care crisis.
Lacey Berumen, Ph. D., of Denver, is the national first vice president of NAMI, the National Alliance on Mental Illness, and the clinical director of the Aurora-based Don’t Look Back Center which empowers women to rebuild their lives from the grip of addiction, trauma, PTSD and domestic violence.