Surprise billing ban will definitely help consumers, but shows fight ahead for further reform

Surprise billing ban will definitely help consumers, but shows fight ahead for further reform

The boon to consumers now being protected from surprise medical bills by a provision slipped into the coronavirus relief bill passed by Congress Monday has a downside. It is a very good thing that the practice of providers making money off of consumers by limiting the insurance networks they participate in isn’t going to fall on patients. Unfortunately, they’re going to get their money one way or another and it could come in the form of higher insurance premiums for everyone.

What’s particularly problematic is the success the powerful healthcare lobby had in fighting it off for months and months, succeeding in watering down the strongest policy prescriptions from bipartisan lawmakers. It doesn’t bode well for future efforts by President-elect Biden, or a potentially Democratic Senate and House, to further reform the system. Physicians and hospitals succeeded in their main goal of keeping lawmakers from setting rates—creating a benchmark payment rate for various procedures based on in-network rates that insurers paid and capping payments there. Instead, they wanted arbitration—taking the uncovered part of claims to a third-party negotiator to determine reimbursement amounts from the patient’s insurer—and that’s pretty much what they got. The bill directs the secretary of Health and Human Services to create a provider-patient bill dispute resolution process.

There are some guardrails. While mediators can’t use Medicare and Medicaid reimbursement rates as their starting point (which would be the commonsense place) they also have to throw out the high charges providers use for providing care, as opposed to the rates they negotiate with insurers. Not allowing “billed charges” as the benchmark rate is a win for insurers. Zack Cooper, an associate professor of public health and economics at Yale who studies healthcare pricing told Kaiser Health News that providers’ bill charges “are totally made up. […] So, the big deal is that arbitrators are not considering charges.”

“No law is perfect,” Cooper said. “But it fundamentally protects patients from being balance-billed,” the industry term for surprise billing from out-of-network medical providers. “That’s a remarkable achievement.” But the millions of dollars spent by provider lobbyists is a horrifying preview for what’s to come when Biden tries to push for the reforms he’s considering, like a public option on the Obamacare exchanges.


From Daily Kos at Read More. This article is republished from DailyKos under an open content license. Read the original article at DailyKos.

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