“First, do no harm” a good rule of thumb for Congress looking at addressing surprise medical billing


Healthcare costs can be ridiculous. This time of year, every time I see a piece of mail from my insurance company, I know what to expect before I even open it. It’s going to be my annual rate increase. I’m a self-employed, single mother, who carries private insurance for me and my three kids and insurance is my second highest bill each month (only a little lower than my mortgage).

I take great care to keep our costs to a minimum choosing in-network doctors and seeking pre-approval for anything out of the ordinary, but life happens and occasionally something isn’t covered. When I had my son last year, I thought I knew what my costs were going to be but somehow, I ended up with a surprise bill a couple months later anyway. The amount was around $400 which is nothing to sneeze at. That’s more than I owe on my two student loan payments combined. 

Still that amount is low compared to the surprise bills that people get when they don’t have the opportunity to pre-plan. Once this issue was brought to my attention, I started researching and found families facing crippling debt for cost there was no way, short of being clairvoyant, they could have planned for. This includes emergency care including ambulance rides, out-of-network costs they incurred at in-network facilities and bills that came from care they thought was covered but wasn’t. It happens all the time. All the time. 

Good news and bad news though. Good news, it looks like Congress is poised to do something to curb this billing nightmare. Bad news, as usual there’s a chance in trying to fix this issue Congress makes things worse.

There are competing pieces of legislation one the STOP Surprise Medical Billing Act (SB 1531) uses a tried and true practice of allowing providers and insurance companies to negotiate prices guaranteeing that the patient isn’t stuck with an ungodly bill and that neither the doctor or the insurance company are alone in dictating or setting prices. The wonky name for this practice is Independent Dispute Resolution (IDR). Basically, IDR brings the physicians and the insurance companies to the table with an incentive for both to negotiate in good faith to come to a compromise that doesn’t leave either party hosed. This concept isn’t a new one about a dozen states already use it and it works. 

The other piece of legislation floating out there relies on the government deciding which rates are best and puts what seems to be a completely arbirtary number at the threashold that doctors or hospitals could start negotiations with insurance companies. This practice, which uses a one-size-fits all approach, experts say would likely lead to doctors deserting rural hospitals and rural areas where the rates would be lowest. As if the residents our rural areas, especially here in Alabama, need additional burdens to finding adequate healthcare. 

Never in the history of government has the government price-set and gotten the prices right. If government had the ability to use good business sense the US Postal Service and Amtrak wouldn’t be such hot messes. I prefer to leave medical billing decisions to those in the medical field with the cavat that the system isn’t rigged towards either party the doctors or the insurers. Any system the government creates will surely benefit one over the other at the cost of patient quality care or access to care.

So where are we on getting these bills through? Well for the senate version the STOP bill there are 27 co-sponsors, 14 democrats and 13 republicans, Senator Doug Jones has signed on (score) but Senator Richard Shelby hasn’t (let’s hope he gets on that). For the House version neither of the current pills have any Alabama support which given the rural nature of our state is just bizarre. Representatives accross the board should be looking to protect those being stuck with surprise bills but if I had to guess this would be an issue straight up the alley of Representatives Martha Roby and Terri Sewell who are known to champion consumer protection bills. Here’s to hoping the new year brings renewed attention to this issue and that the members remember when looking for a solution the Hippocratic Oath nails it when it ask doctors to “First, do no harm,” lawmakers should use that same rule of thumb and leave the playing field level for all the parties involved.