COMMUNITY VOICES: Protecting California patients from surprise medical billing

By Assemblyman Vince Fong
Patients in Bakersfield and across the country continue to rank the rising cost of health care and health insurance among their top concerns. As Congress seeks to improve our health care system overall, one way it could help ensure greater transparency for patients is by ending a practice called surprise medical billing. It’s an issue we’ve discussed in the state Legislature and one that is currently being discussed in Washington, D.C. The United States Congress must address surprise medical billing and do so in a way that mitigates unintended consequences that arise from this complex, costly issue.

All of us can agree that no one should get stuck with surprise medical bills, particularly for emergency care when patients do not have the opportunity to determine (or in many cases don’t know) whether the facility at which they are being treated is in or outside of their insurance network or if the doctor providing assistance is “in plan.” Even when a patient, prior to a hospital visit, does his or her due diligence to make sure that it’s “in-network,” they can still get a ridiculously high bills after their exam, consultation or procedure. According to a Stanford University study, nearly 40 percent of American patients say they have fallen victim to this problem. Congress should work to protect patients from being caught in the crosshairs of payment disputes between their health insurer and medical provider.

To address the full scope of this problem — without threatening access to care or undermining affordability for patients — we need patient-focused solutions. At the state level, California has attempted to solve this problem through cost controls. But this approach, in practice, has proven to be short-sighted. Setting artificially low, fixed rates for providing medical care may on the surface sound like an appealing cost control option, but it creates another problem: access.

Worse still, these artificial caps could put doctors out of business. In fact, California is currently experiencing a doctor shortage, leaving many communities — particularly rural, farming ones like much of Kern County — underserved.

Solely pursuing a government rate setting approach at a national level would only increase the burden that communities like ours face. Instead, Congress should seek to replicate a more workable, functioning model.

The state of New York has experienced success in protecting patients from surprise billing by utilizing an alternative approach. Through the use of independent dispute resolution, state legislators have been able to remove patients from payment disputes between insurers and providers (doctors and hospitals) while decreasing out-of-network costs by 34 percent during the last two years. This process establishes an independent arbiter and system for insurers and doctors to settle price differences.

As Congress weighs the merits of solutions introduced to end the practice of surprise billing nationwide, it is vital that its addresses the unfair costs of surprise billing in a way that does not further harm patient access to health care providers. Ultimately, that means passing a patient-focused solution that relies on the IDR process rather than a heavy-handed, government benchmarking approach.

I have communicated my strong support for IDR to members of Congress in the Central Valley. It’s time to solve the surprise billing problem bedeviling many Americans and do so in a way that puts patients first.

Assemblymember Vince Fong represents California’s 34th Assembly District, which encompasses most of Kern County including Bakersfield, Bear Valley Springs, China Lake, Frazier Park, Golden Hills, Inyokern, Lebec, Oildale, Ridgecrest, Taft and Tehachapi.

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