Michigan Association of Health Plans

We Can End Surprise Medical Bills

No patient should receive a surprise medical bill. Unfortunately, too many Americans are being hit by outrageous bills from a doctor they didn’t choose or didn’t even know treated them in the first place. And in all too many cases, the patient did everything right.

This is unacceptable. But there are proven solutions to this problem. We can protect patients by banning surprise medical bills in situations where patients are involuntarily treated by an out-of-network provider. This is when the patient has done everything right and gone to an in-network hospital but are still billed as out of network.

The patient’s bill in these situations should be capped at the amount they would pay if they were enrolled in an in-network plan. That way, doctors are reimbursed at a reasonable rate for the care they provide, but patients are not unwittingly billed for a choice providers make.

Study after study has shown that the best answer is to implement a locally based, competitively negotiated benchmark reimbursement rate that ensures physicians are properly compensated and that patients are protected. This approach ensures patients retain access to the care they need but takes them out of the middle.

AHIP supports legislation that would establish this benchmark rate – because that’s the proven approach to protect patients and lower costs. The Congressional Budget Office confirms: using a local benchmark to pay for surprise medical bills would save taxpayers $25 billion over 10 years.

What’s the hold up? Private equity firms who own care provider groups and seek to pad their profits at the expense of patients are needlessly sowing fear of ‘fewer doctors.’ But in California, we have seen that a benchmark solution has not only lowered costs but also increased the number of in-network doctors.

Some of these same opponents have suggested that arbitration could help solve this problem. However, arbitration would further allow providers to price gouge patients and then shift responsibility for the final decision about who pays what to a series of bureaucrats and lawyers – but that approach won’t have the best interests of patients in mind. Ultimately, the result would be a higher cost of care and higher premiums for patients. A new report from Brookings shows that arbitration in New York State “is substantially increasing what New Yorkers pay for health care.”

AHIP has partnered with a broad coalition of consumer groups, employers and other groups to advocate for patient-centric solutions to the problem of surprise medical bills. And we stand ready to work with any and all stakeholders to protect patients, lower costs and give patients peace of mind in knowing that they won’t be hit with an outrageous medical bill they never expected.

This article written by Matt Eyles, president and CEO at America’s Health Insurance Plans (AHIP), appeared on LinkedIn. Read more here.

  back to blog