For patients and families struggling to keep up with the high cost of health care, surprise medical bills can often be the last straw. In order to alleviate the burden facing so many Alabamans, Congress must do something to end this unfair billing practice. Just as importantly, lawmakers must pass a solution that ends surprise billing without creating new problems that could threaten access or affordability for anyone.
That is why Congress should oppose any effort to end surprise billing through a particularly risky proposal called benchmarking. Under this approach, the government would be able to set out-of-network rates for physicians. The problem is, these rates would be determined by using insurers’ in-network averages. Because in-network rates include deep discounts that arise during the contract negotiation process, that means a benchmarking solution would drastically slash physician reimbursements.
These financial losses would be passed onto the local hospitals and emergency rooms serving Alabama communities, many of which are already struggling to get by in the face of a growing doctor shortage and high rate of provider consolidation. Benchmarking would only make these problems that much worse, eliminating choice, undermining access, and driving up prices for vulnerable patients.
Congress can avoid these potentially devastating outcomes by focusing on passing a legislative solution that includes Independent Dispute Resolution (IDR) instead of benchmarking. IDR would establish an open, transparent negotiation process through which insurers and providers could settle out-of-network payments among themselves, leaving patients out of the process and only responsible for their normal in-network cost sharing amounts.
Under the IDR process, both providers and insurers would be able to submit their most reasonable payment offers through an online portal. Initial payments made at the beginning of the process would help keep struggling hospitals serving at-risk communities financially stable until a final payment amount is decided by an independent, unbiased mediator. By using third- party data to reach their decisions, these mediators would help ensure fair payments based on the true value of care provided, protecting patients while maintaining access and affordability for everyone.
Senator Doug Jones should be commended for supporting the IDR process through his co-sponsorship of the STOP Surprise Medical Bills Act - bipartisan legislation introduced by Senators Bill Cassidy and Michael Bennet - which includes the IDR framework. Representative Terri Sewell, and the rest of Alabama's federal legislators, should also throw their wholehearted support behind the proven IDR process. It is time to end this unfair practice, and IDR offers the best possible solution to do so without jeopardizing access to vital care for anyone.
Catrena Carter was born and raised in Selma, home of the Voting Rights movement now lives in Birmingham, home of the Civil Rights Movement. Catrena has been working on the front lines of social justice issues for well over 30 years. Catrena is the founder of the non-profit Women Of Will (WOW) to train women to run for office while supporting those women already in office.