Ending surprise billing shouldn’t undermine access to rural health care

Surprise medical billing, wherein a patient receives an unplanned-for bill because their insurance refuses to cover the full cost of a treatment they received, is a problem that impacts the patients we treat at Sheridan Memorial Hospital, and may continue to do so.

Surprise medical billing is a situation borne out of insurance industry policy, and affects patients often without any form of recourse. It occurs primarily in situations in which patients are cared for at “in-network” facilities, but may be seen by an “out-of-network” provider, often in a situation in which a patient has no choice of provider in an emergency situation. I’m glad to see Congress taking the steps necessary to end this practice. However if they take the wrong steps, the bad will get worse for patients across Wyoming, particularly those living in our many rural communities.

Some in Congress are trying to push through a short-sighted solution that would set government-mandated rates for clinical services, transferring significant losses onto local hospitals and emergency rooms and giving insurance companies a major advantage in negotiations. Ultimately, this “benchmarking” approach could increase the rate of provider consolidation, diminishing access and driving up costs for patients living in rural communities. For these at-risk patients who already face high barriers to care, benchmarking would only make it harder to get the care they need to live fuller, healthier lives.

Conversely, another approach called Independent Dispute Resolution has been working successfully in New York State for years, protecting patients while giving insurers and providers a way to negotiate payment terms in good faith. IDR also helps strengthen, instead of undermine, rural health care by providing struggling hospitals and emergency rooms an additional layer of financial stability, preserving access to care for vulnerable patients. IDR will set the cost for patients at or near “in-network” prices, and removes them from the discussion, leaving the provider and insurer to negotiate the remainder of the service charges.

The legislation that some lawmakers are trying to fast-track in Congress right now is a bad deal for patients, ultimately threatening rural health care access. Instead of rushing through this flawed bill, our state’s congressional delegation should work on improving it to incorporate a meaningful, strong IDR framework that truly works for everyone, most importantly, the patients who need our services the most.

 

Kristopher Schamber, MD

Medicine department chair

Sheridan Memorial Hospital.