Patients can help stop Medicare fraud with these steps
As an emergency physician, I recognize that it may not be your best day when you see me, but I do my best to get you treated and back on the right course. What I can’t control, however, is the additional stress you feel when, weeks later, a hefty medical bill that you weren’t expecting shows up in your mailbox .
Surprise billing is an insurance practice that is becoming far too frequent for many Kentuckians.
Fortunately, Congress is working on a bipartisan solution with the patient in mind. Republican Senator Bill Cassidy (R-LA) is leading the charge and recently introduced the STOP Surprise Medical Bills Act. This patient-centered bill includes language to implement Independent Dispute Resolution (IDR), which is the best and truly only option that fully protects patients from surprise medical bills.
It removes patients from the middle of payment disputes and incentivizes providers and insurers to continue working toward an agreement. This is the only way forward. Other proposals would have the federal government step in to set prices, raising costs for everyone and compounding the physician shortage we’re already feeling across Kentucky.
Physicians, especially those of us working in emergency rooms, deserve to be paid a fair market rate for the care we provide, not an artificial one set by bureaucrats in Washington. Policies that put the federal government in the driver’s seat leave physicians and our patients at the mercy of insurance companies, who will continue to ensure their bottom line is protected above all else.
The STOP Surprise Medical Bills Act provides a targeted and commonsense solution to a widespread issue. Relying on a tried and true process—one that’s well understood by the core parties: doctors, hospitals, and insurance companies—this legislation empowers the free market to solve its own mistakes. To be clear, surprise billing doesn’t just happen in emergency departments; it can happen even when a patient visits a hospital that’s covered by their insurer, if during their stay, they receive care from an out-of-network physician or specialist.
The root of the problem has to do with how insurance plans determine reimbursement rates with different hospitals and physicians. Most physicians prefer to be in-network with an insurer because it gives them access to more patients, and they’re more likely to be paid in-full and on time.
However, as the number of insurance plans in the marketplace has grown, hospitals and physicians have become overwhelmed trying to contract with every single available plan. Narrower networks mean patients have access to fewer in-network providers and are therefore at greater risk of receiving a surprise bill even when receiving care at in-network hospitals.
Consumer Reports found a quarter of Americans are impacted by surprise billing. And if that wasn’t bad enough, Kaiser Family Foundation released a study and found 7 in 10 patients with unreasonable surprise medical bills did not realize their health insurance was out-of-network when they received treatment. This practice can leave patients in financial turmoil and only Congress has the power to protect them.
While other proposals tout price controls, the bipartisan STOP Surprise Medical Bills Act, which includes IDR is the only proven solution. Now is the time for Congress to take meaningful action and truly protect patients and their families from having their financial future held hostage.
Dr. Robert Couch is an emergency physician in Louisville and secretary-treasurer of the Kentucky Medical Association.