Protect patients from surprise bills, insurance profit taking

I’m glad Congress is taking a look at surprise bills, as it is a problem that needs to be addressed. However, I am concerned about current legislation that has been proposed because it helps insurance companies by giving them power to set physician rates.

Insurance companies are already making a lot of money on surprise medical bills. Patients often receive these bills after emergency treatment, when they did not have an opportunity to plan which doctors they would use. Patients also receive surprise bills after visiting a clinic or hospital that was in-network, but one or more doctors assisting with their case was out-of-network. The insurance companies continually find ways to exclude providers from their networks, making it harder for patients avoid out-of-network charges.

Proposed legislation in Congress sets benchmark rates for out-of-network care based on the median in-network rates charged by insurance companies. Over time, insurance companies could manipulate the median rate by excluding more expensive providers. Physicians would have no ability to bargain for better rates.

We should not allow insurance companies to set physician rates. We can predict how physicians will react to these changes, and it does not bode well for the patients Congress is trying to help.

Some physicians will decide to stop offering certain services. This already happens with physicians who will not see Medicare and Medicaid patients. In areas with a limited number of providers, patients will lose access to some services altogether. They will have to travel farther and wait longer for the care that they need.

The benchmark rates also could put some providers out of business, especially in rural areas where there is only one insurance provider. Insurance companies will continue to push compensation rates lower. Providers will have no choice but to accept the benchmark rates, regardless of the cost of providing services. The end result: Patients will lose access to care.

Emergency services will suffer the worst. When cash-strapped hospitals and clinics go under, patients are left with fewer options for emergency care. Whatever the solution to surprise billing, it must not jeopardize patients’ access to emergency services.

Diane Smith

Oakland County Resident