As a radiologist, I give my patients the ability to see what cannot be seen. This allows the patient to understand what is going on with their body, make arrangements for their immediate future and, most importantly, eliminate doubt when it comes to their health and recovery.
Unfortunately, there is a different kind of surprise that has become more pervasive in recent years. That surprise comes in the form of medical billing, and surprise medical billing generally impacts trauma patients or those in need of emergency care. As the president of the California Radiological Society, I would be remiss if I did not mention the impact it has had on patients treated by radiologists, pathologists and anesthesiologists.
It occurs when an out-of-network healthcare provider treats a patient, and the patient’s insurance company refuses to cover the cost of that treatment. This places the provider and the patient in an untenable situation, where life-saving or necessary care has acted as the genesis of financial burden for those who have paid their premiums each month and expect to be covered in emergency situations — no matter the time or place.
Fortunately, our federal government is committed to solving this problem, but it is the method used to address this issue that matters most. As we look to the states for data and examples, it is clear that one method has worked and one has not.
The method used by California has left the state’s health care system worse off than when it started. By artificially capping rates for providers and setting out-of-network reimbursements at a rate legally tied to the in-network rate, providers have been stripped of their ability to negotiate the cost of care and insurers are now free to manipulate these rates in order to deny appropriate reimbursement for out-of-network providers.
Insurers in California now offer “take it or leave it” negotiations with doctors who can elect to join an insurance network at an unreasonably low rate or go out of network, where they will also be reimbursed at an unreasonably low rate.
New York has come up with another option which has resolved nearly 2,000 disputes and decreased out-of-network medical costs by nearly 34 percent over the last two years. Most importantly, it protects patients and removes them from financial disputes by utilizing an Independent Dispute Resolution System or “Baseball-Style” arbitration model, where an independent third party helps to decide the cost of care between insurers and providers.
This proven approach provides our representatives with a framework to address this major issue, and an opportunity to pass a law that takes patients out of the middle of financial disputes between providers and insurers, and focuses on the well-being of those in need.
Dr. Mark Yeh is the president of the California Radiological Society.