No matter where you live, how much you make or your political affiliation, no one wants to receive a huge surprise medical bill, and most agree that that no one should.
Sometimes, that medical bill is not the standard co-payment you expect, but hundreds, thousands or even tens of thousands of dollars because your health provider was unwittingly out-of-network. We can hopefully also all agree that to solve this problem, we don’t want to create another one by increasing premiums. That’s why the action taken in California – and now hopefully by Congress – to end this practice and prevent increased health care costs is so encouraging.
As a health consumer advocate, I have heard many stories from around the state, including in Bakersfield, about people’s experiences with surprise medical bills. These huge bills can get sent to collections and destabilize a family’s finances. Many times, these patients even made a point of going to an in-network hospital, but were still seen by an out-of-network doctor that they had no control in choosing, like the anesthesiologist or radiologist.
Patients who do the right thing should only be responsible for the in-network cost-sharing they accepted as part of their health plan, and no more.
But this problem can’t be solved on the back end by allowing providers to charge insurers whatever they want in compensation for their services. Taking patients out of the middle should not come at the expense of higher premiums for everyone. The best solution to lower health care costs across the board is to set an average payment rate that accounts for regional price variation and is fair for providers.
This is exactly what California did three years ago. With Assembly Bill 72, advocates for consumers, business and labor passed protections for patients from surprise medical bills, and also from inflated premiums. It established a benchmark for provider payments, set at the average of what in-network providers are paid. If someone thinks that rate, set by the market negotiations between insurers and providers, is unfair, they can appeal.
Three years later, the flood of appeals that was predicted was in reality only a couple dozen. The vast majority of providers have accepted the rate as payment in full. And millions of Californians have been protected from having their credit ruined and their financial future placed at risk. Not only that, but a recent report by Health Access, analyzing data from the Department of Managed Health Care, found insurers have broadened their networks, and contracting continues to be widespread.
This California compromise is a success story and should be the basis for a national solution, extending these protections to millions more across the country — including in our state. Even though California’s law is seen as one of the most comprehensive, more than five million Californians are in large employers with federally-regulated health plans that are not covered by these protections. An additional one million Californians are in plans at risk of surprise emergency room bills too. We need Congress to pass a comprehensive solution now.
California has Congress members on the key committees considering these proposals. Congress has a small window of opportunity to pass these important protections against surprise medical bills this fall. We urge our California representatives to join with consumer and health advocates, business and labor to support the solution that has worked in our state. Together we can end surprise medical bills for millions while also protecting consumers from unnecessary health care cost increases.
Anthony Wright is the executive director of Health Access California.