Las Vegas Sun

August 18, 2019

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Guest column:

We can end surprise billing without sacrificing patient access to care

Nevadans, like all Americans, deserve access to affordable, reliable and high-quality health care. Unfortunately, all too often, the high cost of care and limited access — especially in rural parts of our state — create barriers to receiving the treatments and services patients need. A key contributing factor that only makes matters worse is the rising incidence of surprise medical billing. This is a national problem that affects some 140 million Americans — and it requires a national solution.

Surprise billing happens when a patient receives medical care from an out-of-network hospital or emergency department, which is a common occurrence — especially in rural parts of the state where the nearest health care facility may be in the next county over. Weeks after being discharged, patients are slapped with a huge bill for the cost of care not covered by their insurance plan. Surprise billing can even happen when a patient visits an in-network facility but receives treatment from an out-of-network doctor or physician. Due to the abundance of insurance plans on the market, it is simply not feasible for every health care provider and facility to contract with every insurer. And given the trend insurers decreasing the size of their provider networks, patients are more likely to receive out-of-network care and, therefore, be hit by a surprise bill.

We are proud of the work we are doing in the Nevada Legislature to take charge of this issue at the state level. During this year’s legislative session, we took steps to address surprise billing by passing Assembly Bill 469. The bill prohibits out-of-network providers who administer medically necessary emergency services from charging people more than the copayment, coinsurance or deductible required by the patients’ policy.

Should any disputes arise — either from the health insurance provider or the patient — our legislation outlines an arbitration component to find a resolution that takes the patient out of the dispute. This would greatly benefit a host of Nevadans with health coverage who may find themselves in an out-of-network hospital receiving treatment from an out-of-network provider in an emergency situation. While these are important steps, we must address surprise medical billing at the national level as well.

That is why it is imperative that Congress pass legislation that fixes the surprise billing issue in the right way, one that involves an arbitration component that is similar to the one we passed. Currently, the Senate is considering just such a bill, the STOP Surprise Medical Bills Act, which was introduced by Sens. Bill Cassidy, R-La., and Michael Bennet, D-Colo., and includes a strong and effective Independent Dispute Resolution framework. We are grateful that Sen. Jacky Rosen, D-Nev., has also signed on in support of this bill, which would help protect patients while keeping our local hospitals strong.

However, senators are also working on a much larger health care package, the Lower Health Care Costs Act — which is the more likely vehicle by which surprise billing provisions will be passed. It is imperative that senators work to include the kind of arbitration framework present in the STOP Surprise Medical Bills Act in the Lower Health Care Costs Act.

Independent Dispute Resolution essentially brings insurers and health care providers to the negotiating table, providing incentive for each party to bring their best offer in front of an impartial mediator who then determines a fair reimbursement rate. In the interim, hospitals receive a temporary payment based on the market value of their services. This helps ensure financial stability for our health care facilities, particularly ones in rural regions that operate on razor thin margins. It is an approach that has worked wonders in New York, which passed state-level legislation that includes the IDR process, helping protect patients, enhance transparency, increase network care and control costs.

Currently, the Lower Health Care Costs Act takes a misguided approach to ending surprise medical billing. It would use what is known as benchmarking to determine payment amounts for health care providers. Benchmarking would put the federal government in charge of setting rates, creating a one-size-fits-all approach that disregards the widely differing levels in difficulty and cost of care across different geographical locations and health care settings.

Benchmarking could end up shortchanging doctors and hospitals to the tune of billions of dollars a year. These costs could end up contributing to greater provider consolidation, threatening patient access and choice. Moreover, many of the facilities that would be hurt the most by a benchmarking approach would be the ones that provide critical safety net services for patients who are uninsured or on Medicare or Medicaid.

Benchmarking is the wrong tactic to take to end surprise medical billing. This approach would undermine the strength of local hospitals and their ability to more effectively serve our communities. Any legislation that Congress passes must include the IDR framework in order to preserve access to quality care for Nevadans and all Americans.

Jason Frierson represents District 8 in the Nevada Assembly, where he serves as speaker. Maggie Carlton represents District 14 in the Assembly.