Surprise Billing

I’m from Congress, and I’m here to help!


At some point, we all find ourselves in need of emergency, sometimes life-saving, care.  Over the last ten months, many American’s have found themselves in the Emergency Department of their local hospital being treated for Covid-19.  One of the great things about our health care delivery in this country is that when you walk or are brought into an ER, you are treated by a team of highly trained professionals who deliver the best emergency medicine available in the world.  They treat you regardless of your insurance coverage or your ability to pay.  The doctors who staff these ERs agree to provide care 24/7  to everyone who walks through their door.  They have done this for decades.  During this pandemic, they are doing so at risk to themselves and their families.


For the last year or so, a debate has raged in Congress about the issue of surprise billing.  Surprise billing happens when you go to an ER, and your insurance company doesn’t have a contract with the physicians who staff that ER.  In that situation, you will get a bill from the ER doctor for whatever amount your insurance doesn’t cover.  That bill is often a surprise to the patient because since the hospital was in your insurance network, the patient assumed the ER group was as well.


These surprise bills can be the result of a group that refuses to contract with an insurance company or, more often than not, because the insurance company was unwilling to compensate the ER group at a rate that was necessary for that group to provide the 24/7 care and staffing required by that facility.


The solution being developed in Congress is to pass a law making it illegal for ER doctors and other hospital-based physicians to balance bill patients.  If passed, this bill would give the insurance companies incredible power and leverage over these physicians.  Think about this for a moment and try to imagine any other profession that has to work under these kinds of regulations.  This law would take a profession that is already required to sell their services to anyone and everyone regardless of their ability to pay and force them to accept as payment in full an arbitrary amount primarily controlled and determined by an insurance company.  Can you imagine calling a plumber in the middle of the night when you have a pipe that burst and telling him that he had to come fix your pipe and that you don’t care what he charges, you were going to pay him a fraction of that amount as payment in full.  Try that sometime and see how fast that plumber hangs up on you.


Now the insurance companies will tell you stories about groups billing absurd amounts of money and using their monopoly power to reap huge profits and fees.  They will talk about how much this costs the American people and how they need this legislation to combat these profit-seeking behaviors.


The problem with that argument is it’s just not true.  Sure, there are anecdotal stories of absurd bills, and sure, there are bad apples in any profession.  Those situations should be dealt with, as they are unacceptable.  However, when you look at the data, it’s clear that Emergency Medicine physicians are not abusing their situation, and they are not getting rich by any means.


In 2019, 12 other medical specialties were said to make more money on average than ER doctors.  Specialties like Dermatology, Ophthalmology, and Plastic Surgery all make more money than ER doctors.  Over the last five years, the salary of ER doctors has gone up by an average of 3.3% per year.  The average wage index for all US workers went up by 3.2% per year during that same time period.  Yep, you got us.  We have been killing it in Emergency Medicine to the tune of an extra 0.1% per year.  Over that same time period, United Health Care’s stock price went up an average of 37.6% per year.  Hmm, it makes you think that maybe the doctors aren’t the problem here, doesn’t it?


Yes, we need to address the bad apples that over-bill and take advantage of people who are at their most vulnerable.  There is no argument about that.  However, this one size fits all, overcompensating reaction by Congress and pushed by the insurance industry is not the answer.  A surprise billing law from Congress is likely to produce more harm than whatever good it does.


During this pandemic, we were once again reminded that our front-line health care workers are heroes.  There is no place closer to the front line than our hospital Emergency Rooms.  We need to be very careful and support these heroes.  If we don’t, and if we pass an ill-conceived piece of legislation, we might find that they are not there the next time we need them.


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