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Doctor: Alexander's surprise medical billing legislation could drive up costs

Dr. Landon Combs, Guest Commentary • Jul 10, 2019 at 12:00 AM

Lawmakers in Washington, D.C., have finally heard enough complaints from patients who are frustrated with unexpected medical bills, and one of our local congressmen is leading the charge on a possible bipartisan solution.

Last week, U.S. Rep. Phil Roe, M.D., R-Tenn., and Raul Ruiz, M.D., D-Calif., introduced the Protecting People from Surprise Medical Bills Act. The draft bill still needs to improve in some areas and will likely change as it moves through the legislative process, but, in principle, it would free patients from the burden of surprise medical bills by creating a fair process for healthcare providers and insurance companies to resolve payment disputes without involving the patient.

Patients who have experienced surprise medical bills in the current system are understandably confused by charges beyond their expected insurance co-pays and deductibles, from a provider in most cases they did not even have the opportunity to choose. This is a byproduct of health insurance companies’ efforts to cut costs by allowing fewer providers in health plan networks. So, even if a hospital is considered in-network, it does not necessarily mean all physicians involved in the care within that site have been able to contract with the health plan, and patients ultimately pay the price in the form of a surprise bill.

The Tennessee Medical Association has worked on this issue for a number of years at the state level but has been hopeful this year that Congress will find a practical solution that holds patients harmless and protects doctors’ right to fair compensation for the services they provide.

A group of TMA member physicians traveled to D.C. last week to talk with lawmakers about the issue. Sen. Lamar Alexander has included a proposal to address surprise medical bills in a broader legislative package introduced last week called the Lower Health Care Costs Act of 2019. While his proposal also keeps patients out of the process, it would allow health insurance companies to set the rates they would pay without negotiating with physicians or other healthcare providers. Physicians are concerned it may address the symptom but not the root cause of surprise bills and actually drive up healthcare costs with some unintended consequences.

We need a simple solution to this growing problem that removes the financial burden from patients and is reasonable and fair for the doctors who deliver care.

Tennessee physicians are proud of our colleague Dr. Roe for stepping up for Tennessee patients. We will stay engaged with state and federal legislators as we look for a solution to end surprise medical bills.

Dr. Landon Combs is a pediatrician with Ballad Health and the regional physician representative on the Tennessee Medical Association Board of Trustees.


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