“This is the lowest hanging fruit there is. If we can’t even do that, you might as well run up the white flag.”Michael Miller of Community Catalyst.
A lot has been written in the last few years about health insurance, yet one factor has not been sufficiently discussed, “surprise billing.” You may believe you have healthcare coverage… when you do not. For example, maybe you used providers that you believe are in your insurance plan when they are not or had a procedure that you thought was covered but wasn’t, sticking you with a higher bill than is reasonable. Or any one of a number of strange twists leaving you without coverage. Even for those with large employer coverage, 16% of Georgians having inpatient stays had one or more out-of-network charge.
Senator Perdue is in a tough election campaign. The Democrats nearly won back the Governor’s office in 2016 and are targeting him in 2020. That’s why a shadowy mistitled lobbying group, Doctor Patient Unity (DPU), went after him on the medical billing issue, as discussed below.
Last year, a bi-partisan group of in the House Energy and Commerce Committee put out a positive “balance billing” discussion paper. But, although the House and Senate together have since drafted five bills, that’s about as far as it has gotten due to massive spending and pressure from DPU, a shadowy, dark money lobbying group.
Perdue and other Senators and Congressmen in tough races were fiercely lobbied to kill strong surprise billing legislation in favor of the so-called Cassidy Bill. Perdue caved in, as evidenced by the numerous self-interested ads sponsored by DPU praising Perdue’s support of a very weak bill that helps for-profit hospitals and other providers rather than powerless, mistreated patients. (see “Vulnerable GOP senators move toward provider-friendly surprise billing proposal,” Modern Healthcare, 3-6-20)
Surprise billing is an issue that must be addressed. I spent virtually my entire career in healthcare, and have two sons who are MDs, but I have still run into the coverage issue in my own family’s care. For example:
- being told after the fact that a surgical procedure would not be paid for by the insurer or that I would have to pay a large “out of network” copay for an unknown surgeon assisting my “in network” surgeon;
- having the claim for a physician ordered test rejected as unneeded and then being the physician has no financial responsibility; and
- having a physician’s office say that they take Medicare, submit invoices incorrectly and then come back to me to pay the bill, with full charges (not the lower amount paid by Medicare).
Because of my healthcare background, I was able to straighten out these situations, maintaining my 800+ credit rating. But, how about the working men/women who don’t know the score?
Bi-partisan legislation is needed right now which will:
- stop out of network providers from sticking the unknowing emergency patient with surprise bills that are higher than for an in-network provider;
- require deductibles to be the same for in-network and out-of-network providers; and
- set the minimum amount a plan must pay to the out of network provider.
These actions are a good start but are very limited. What is the best ultimate solution? Having fewer payers/insurers is a large part of the answer. With expanded Medicare for All, virtually all credentialed physicians would participate; there is no out of network unless the provider is 100% private pay (i.e. doesn’t accept insurance at all). Further, regulations would be structured which put providers (versus patients) on the hook for unnecessary tests and procedures. The bottom line is that under Medicare for All patients are never billed.
For those who say comprehensive single payer is too expensive, please be aware that our national per capita healthcare expenditures are currently the highest in the world (while our healthcare system has major issues as shown by the COVID-19 situation). For example, we are almost double Canada and France. Further, these democracies provide full coverage for everyone, have better outcomes, better access and still manage to spend less. The only thing holding us back is political will and backbone.
Meanwhile, weak-kneed Senators like Perdue are being successfully pressured to support the Cassidy Bill, which leaves patients out in the cold. When you go to vote, think about to whom Senator Perdue is beholden. And why he’s supporting a watered-down sham of a bill instead of advocating for a strong law which would protect patients.
Image Credit: the feature image of raining dark money on Sen David Perdue was created by LikeTheDew.com from an illustration of Georgia Senator David Perdue was created by DonkeyHotey (Flickr/Creative Commons); and series of photos by ekinyalgin licensed by LikeTheDew.com at 123RF.com using contributions from generous readers like you (please click here to keep LikeTheDew alive).