On October 13, 2016, the Brookings Institution hosted an event called “How To Protect Patients From Surprise Medical Bills.” As someone deeply interested about the effects on healthcare access and how, ultimately, healthcare access is a proxy for positive health outcomes, I wanted to gain more perspective on how healthcare coverage does not necessarily equal care; having health care insurance does not mean that you will receive adequate care. Surprise medical bills are the product of gaps in coverage or gaps in knowledge of insurance plans. They can also be a by-product of patients purposefully going out-of-network for care without realizing the full consequence of that action. This results in patients being saddled with unexpected medical expenses. The event was structured around two presentations and two panel discussions, all of which centered on proposing solutions for surprise medical billing. Panelists and presenters consisted of individuals representing health insurance providers, policymakers, and physicians.
Despite being from different backgrounds and representing different interest groups in the matter, the panelists and presenters wholly agreed that requiring consumers to go to mediation about their medical bills is bad idea. Presenters offered slightly different solutions to the issue. Some solutions set forth included:
I came to this realization when the only physician on the panel gave a dissenting opinion on the matter. He purported that the solutions being presented, discussed, and, in some states, implemented are only treating the symptoms of the disease, and not the disease itself: gaps in health insurance coverage. Surprise medical bills are a direct result of the confusing structure of health insurance plans. Not only is the jargon used in health insurance inherently riddled with industry-specific terminology, but also the actual structures of the plans, themselves, are misleading. A lot of insurance companies operate on a tier system with different benefits and coverage attributed to the different tiers. For example, a provider may be in network for one tier and out-of-network for another tier. This physician also made the argument that the claim that physicians are colluding to trick insurers and patients into paying more is entirely false. He asserted that physicians want to be in-network and that the anecdotes about physicians sending big bills are only applicable to a very small minority of physicians. The solution to this problem, in his opinion, can be explained by the acronym, BIG: Ban Big Insurance Gaps.
This event was on a very particular topic within healthcare, but highlights a major obstacle in the overall health field. In a system where all stakeholders should be working in tandem with one another, they are clearly not. A main takeaway for me from this event is further evidence of how necessary collaboration is when it comes to healthcare; our health system is built by economists, policy makers, insurance providers, and physicians and all parties should be a part of the solution.
Despite being from different backgrounds and representing different interest groups in the matter, the panelists and presenters wholly agreed that requiring consumers to go to mediation about their medical bills is bad idea. Presenters offered slightly different solutions to the issue. Some solutions set forth included:
- Comprehensive approach
- Solutions should target all out-of-network billing at in-network facilities, in addition to covering all care given in emergency settings
- Federal protection of patients
- There should be a federal solution to the problem (i.e. extending the ACA to protect patients in emergency settings) or legislation that provides to each state the authority to adapt to local market conditions
- Hold patients harmless
- Ban balance billing and charge only in-network deductibles
- Encourage in-network participation/change care structure
- Encourage pay for bundle services from physicians and hospitals to contract with in-network physicians and vice versa
- Develop some form of dispute resolution or regulate provider rates in surprise situations
- Utilize baseball style arbitration
- Make rates 125% of Medicare or determine rate by average in region
I came to this realization when the only physician on the panel gave a dissenting opinion on the matter. He purported that the solutions being presented, discussed, and, in some states, implemented are only treating the symptoms of the disease, and not the disease itself: gaps in health insurance coverage. Surprise medical bills are a direct result of the confusing structure of health insurance plans. Not only is the jargon used in health insurance inherently riddled with industry-specific terminology, but also the actual structures of the plans, themselves, are misleading. A lot of insurance companies operate on a tier system with different benefits and coverage attributed to the different tiers. For example, a provider may be in network for one tier and out-of-network for another tier. This physician also made the argument that the claim that physicians are colluding to trick insurers and patients into paying more is entirely false. He asserted that physicians want to be in-network and that the anecdotes about physicians sending big bills are only applicable to a very small minority of physicians. The solution to this problem, in his opinion, can be explained by the acronym, BIG: Ban Big Insurance Gaps.
This event was on a very particular topic within healthcare, but highlights a major obstacle in the overall health field. In a system where all stakeholders should be working in tandem with one another, they are clearly not. A main takeaway for me from this event is further evidence of how necessary collaboration is when it comes to healthcare; our health system is built by economists, policy makers, insurance providers, and physicians and all parties should be a part of the solution.