Congressional Delegation Should Prioritize Doctors And Patients Over Big Insurance Companies

Have you ever heard of surprise billing? If you or someone you know had a medical emergency during your family vacation this summer and had to visit an ER, then you may be all too familiar with this problem that is affecting families all over America. 

Surprise billing happens when you unknowlingly visit a healthcare provider outside of your health insurance network, and then you receive a bill for hundreds, thousands or even tens of thousands of dollars in the mail. 

As if getting sick while traveling wasn’t bad enough, now you find out you are on the hook for medical bills you didn’t expect and probably can’t afford! 

Surprise billing is both a national problem and an Alabama problem. Alabama already suffers from a shortage of healthcare options, especially in rural communities. And while Congress wants to fix the problem, not all proposed solutions are equal. 

One proposed solution, the “Lower Health Care Costs Act” put forward by Senator Patty Murray (D-WA) and Senator Lamar Alexander (R-TN), attacks this problem the wrong way by using a median in-network reimbursement rate as the benchmark for insurance companies to pay out-of-network health care providers. 

In other words, it sets the reimbursement rate doctors can charge. While on the surface this might seem like a reasonable option, it’s not. 

This option gives health insurance companies far too much of an upper hand. Essentially, this allows them to dictate reimbursement rates to out-of-network providers, and gives them every reason to drop in-network providers who are above the median rate. Insurers can manipulate both the in-network and out-of-network rates and limit their financial burden by cancelling contracts and offering new ones well below fair market value. 

Considering that health insurance companies have watched their profits increase by $12 billion over the past five years, there is no reason to give them the benefit of the doubt here. You may very well see doctors closing down their offices or hospitals going out of business, especially in agricultural or under-served areas. You would definitely see networks shift and shrink. 

Either way, it means patients would have fewer options as doctors and hospitals are forced out of business. 

Affordable healthcare is a serious problem, and no one seems to have the right answer – at least not one that a majority of American’s can agree on. But what we can all agree on is that the big health insurance companies that are looking to increase their already massive profits at the expense of patients and healthcare providers shouldn’t be the ones writing national healthcare policy. 

I would urge the members of Alabama’s Congressional delegation to think long and hard before putting billion dollar insurance companies who have huge profit margins over Alabama providers and Alabama families. Surprise billing is a terrible problem. Let’s not make it worse by letting the foxes in the henhouse. 

Craig Ford is the owner of Hodges-Ford Insurance and the Gadsden Messenger. He represented Gadsden and Etowah County in the Alabama House of Representatives for 18 years.