Why would the Texas Medical Association “strongly oppose” legislation to stop patients from getting surprise bills?
…And why I strongly oppose their opposition.
Surprise billing from hospitals, in case you are unaware, is a common reason that smart, sensible and financially sound people in the United States go bankrupt.
One example is John Stockman, who went to the Emergency Room in the middle of a heart attack. He left with a bill for a million dollars, despite having decent insurance. John Stockman is not alone. 54% of Americans say they received a medical bill in the last year for care they thought was covered by their health plan. A staggering 1 in 7 in-network hospital admissions results in a surprise bill.
Surprise billing happens when an ambulance takes you to the closest hospital which just happens to be out-of-network. It happens when you triple check your surgery is covered and then find out, after receiving a bill for more money than you have in your savings account, that the anesthesiologist was out of network. It happens when your regular doctor does a blood test in his office and you get a bill for $531.71 fully one year after your visit. Like I did this morning:
With a note, by the way, to keep this a secret from my doctor:
But let me refrain from getting distracted by a mere $531 when someone in my office got a bill for over $2500 for services rendered during a “covered” colonoscopy. Despite going all the way to the state level to fight it, he still had to pay the full bill. Or this woman who went to ER after being bitten by a stray cat and got a bill for $48,000.
Point is, anyone who thinks they are inured from surprise billing because they are too smart or sophisticated or has too good insurance could be woken up, (perhaps literally in a hospital bed) to a very costly surprise.
I was under the mistaken impression that doctors, such as those who form the Texas Medical Association, would be all for removing surprise billing. Doctors know that “financial toxicity” is a well-proven reason why patients do not get care they need. People choose to have their heart attack at home or don’t seek medical care for their pneumonia because they fear the unknown sticker shock.
Many doctors I know form an unwavering front line doing everything they can to help patients despite burn-out and long hours and a granite commitment to do no harm. Therein lies the conundrum.
Given the harm it causes patients, what possible reason could the decision-makers at the Texas Medical Association have for “strongly opposing” a proposed law to eliminate surprise billing?
And here’s your answer.
Let me quote from a February 2019 Brookings Institute article on surprise billing:
“As a result, ED and ancillary physicians, as well as hospitalists and ambulance companies, have a potentially lucrative out-of-network billing option that is unavailable to almost any other provider. And not surprisingly, given that the amount charged to out-of-network patients faces few market constraints, emergency medicine and ancillary physicians have much higher charges (or “list prices”) than other specialists relative to Medicare payment levels on average, with extremely high charges at the top end.”
Oh ok. I get it now. Some doctors choose to make a fortune off unsuspecting people. People who are incapacitated, or at least badly injured, and easy marks to get their savings accounts emptied out. Other companies, like one called EmCare have basically turned surprise billing into a business model.
What can you do to combat surprise billing right now?
Write Alex Azar, Secretary of the U.S. Department of Health and Human Services, who has pledged to eliminate surprise billing. Here’s his contact info.
Updated 5/16/19: Lots of legislation pending around surprise bills:
Lawmakers from both parties are ramping up efforts to stop surprise out-of-network health care bills. A draft bill unveiled by members of the House Energy and Commerce Committee would tackle the issue; Sens. Bill Cassidy, R-La., Michael Bennet, D-Colo., and Maggie Hassan, D-N.H., plan to release a bill this week; and Senate Health Committee Chairman Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash., are including the issue as part of broader efforts to reduce health care costs: The Hill
The thing is, this proposed legislation advantages insurance carriers. It creates a situation where carriers can negotiate really low compensation for doctors because even if a doctor doesn’t agree to go in-network, they have to take that low payment anyway. Let’s not forget this is an issue with some complexity and insurance carriers are assuredly part of that complexity. Furthermore, their actions heretofore have not been heroic. Proposed solutions have included pricing and contract transparency.
“The last thing a patient should worry about in a health crisis is an unanticipated medical bill. We must protect patients from surprise bills that could unintentionally impact their out-of-pocket costs and undermine the trust and confidence patients have in their caregivers.”
Please join me in keeping an eye out for the actions the AHA takes relative to surprise billing. My greatest hope is that their work and lobbies are aligned with their words.
