
Ideas to Curb Surprise Medical Bills Percolate with Rare Bipartisan Push - arkades
https://www.healthleadersmedia.com/finance/ideas-curb-surprise-medical-bills-percolate-rare-bipartisan-push
======
arkades
I'd be really happy to see surprise billing come to an end. I'm not sure
there's a good of way doing it, though. There's a fundamental tension:

(1) People often need care quicker than their financial and insurance
situation can be established. Insurance companies love to deny claims
_retroactively_ , which by definition won't hit people until well after
necessary care has been provided. Requiring pre-authorization for _everything_
from insurers is a huge problem, in terms of time, illegitimate denials, and
the amount of overhead it creates for providers (having to hire staff just to
sit on the phone with insurers all day.)

(2) This creates an incentive to provide minimal care to folks. If the
provider or hospital is left entirely on the hook for eating the cost of a
denied claim, and can't ethically deny care, the result is going to be pretty
much everyone getting the same care that homeless folks coming in off the
street get: absolute minimum care necessary to stabilize, then get out. Go
spend a week sorting out your pre-authorizations, and then come back. This is
the effect you'd get from the Cassidy bill, Hassan, or Doggett.

(3) This creates a serious amount of leverage for insurers. Right now, part of
what keeps insurers at least somewhat in check is that providers refusing to
participate in their networks requires insurers to negotiate reimbursement
rates to attract physicians, in order to attract patients. Patients won't go
to out-of-network providers due to the expense. In this instance, the insurer
can cut back on the number of providers in their network. Patients will avoid
out of network care as long as they can, eventually present in an emergency,
and score in-network prices anyway - which means the insurer gets to pay for
fewer visits at reduced costs, while being able to negotiate reduced
reimbursement rates all around.

Every single one of these proposals basically says "if anything happens, the
provider eats it." There's not a single mechanism included to share the "eats
it" with the insurer, or to prevent insurer abuse. This creates a major
incentive for insurers to game the system to shift their costs to providers,
by aggressively denying even more claims, knowing that there won't be any
consumer backlash for it.

Part of this has to do with trying to protect emergency coverage. I think the
ACA already covered this reasonably well, and it's just a clause that needs to
be vigorously defended: __all emergency room care is in-network, period __.
But this was laid at the feet of insurers. I 'm somehow less than shocked that
the new round of bills seeks to shift the entire burden, emergency or not,
from insurers to providers... despite the fact that the "surprise" component
of surprise billing is almost entirely a function of insurer behavior.

