BY REP. PHIL ROE
One of the most infuriating experiences for patients in our health care system occurs when they seek care at what they believe is a facility covered by their insurance, only to find out weeks later they were treated by an out-of-network physician — without the patient’s knowledge — and are now faced with a substantial surprise medical bill. Patients and families have endured financial stress and other hardships because of these costly bills, with surveys showing nearly 67 percent of Americans are worried about unexpected medical bills and 37 percent are very worried. Surprise billing happens to patients in every walk of life; I have also received a surprise medical bill as a patient. We must put an end to this practice.
As a physician, I believe it’s imperative we act to protect patients from this worry, and I am grateful President Trump is leading the way. What I know from experience is that surprise bills occur when providers and insurers cannot agree on fair reimbursements. As a member of the House Education and Labor Committee, I stated at a hearing in April examining this issue that I have seen how surprise bills arise since I have been negotiated out of health care networks. There are no innocents in this when you look at insurers, hospitals and providers. Everyone is culpable, but Congress does not need to invent a new solution to fix this problem to hold patients harmless when negotiations break down. Our states have provided excellent examples for a path forward.
For that reason, I am proud to be working with Rep. Raul Ruiz, M.D. to introduce bipartisan legislation, the Protecting People from Surprise Medical Bills Act. This legislation is based on a successful model in New York state to resolve medical billing issues that uses an independent dispute resolution (IDR) process when an insurer and provider cannot agree on the cost of care. This legislation will also ban the practice of billing patients for unanticipated out-of-network care and improve transparency by requiring health plans to clearly identify in-network providers and patient deductibles. Within three years of implementing its arbitration legislation, New York’s surprise bills have declined by 70 percent. This arbitration process, which some people refer to as “baseball-style” because it resembles the process used by Major League Baseball to resolve salary disputes, is fair to everyone. The process ensures patients do not receive unanticipated bills and gives providers and insurers a neutral arbitrator who can resolve disputes about who is responsible for the cost of providing care.
As President Trump highlighted at the White House on May 9, currently, 29 states have no patient protections for surprise billing, and these bills often cost many thousands of dollars. The president gathered a group of patients impacted by surprise bills to discuss how best to address this problem. One of the patients, Drew Calver from Austin, Texas, shared his story about having a heart attack and receiving urgent care at the nearest hospital. Although Mr. Calver had insurance, he was billed $110,000 and said that he felt exploited while he was in a vulnerable position. Similarly, a patient in Texas was asked to take a urine drug screening after having back surgery and receiving pain medication — a test that costs roughly $100 — but her family was billed around $17,850 a year later. Stories like these are too common and highlight the urgent need for action.
I am proud to be leading the House GOP Doctors Caucus in encouraging a solution that can be signed into law. Last week, we wrote a letter to the Trump administration’s lead officials on this issue to call on the administration to use this proven New York-style arbitration model to protect patients from having to bear the burden of surprise bills. Thanks to President Trump’s leadership, I am hopeful Republicans and Democrats will be able to find common ground on this issue as Rep. Ruiz and I have done.