Congress: End surprise billing without compromising patient care

The cost of health care in New Hampshire and across the country is quite simply too high, preventing many patients from accessing the vital services and procedures they need to live healthier lives. That’s why, as Congress returns to session in the coming weeks, they must recommit to efforts to end the unfair practice of surprise medical billing.

Surprise billing has been a problem for far too long — and it is only getting worse. Patients seeking care should not have to worry about being caught off-guard while they are in the midst of recovery by high, unexpected bills for medical care they didn’t even realize was out-of-network until it’s too late.

Fortunately, Congress has a head start on this matter as several bills have already been introduced this legislative session that seek to address this issue. Unfortunately, some of these bills would only create new headaches and barriers to care for patients. That’s why it’s absolutely critical for Congress to get this right.

Doing so means avoiding proposals that offer government benchmarking as the solution to surprise medical billing. A benchmarking approach would put the federal government in charge of determining and setting rates for physicians. Such a one-size-fits-all approach would inevitably result in drastically lower rates for many doctors, passing enormous financial losses onto our nation’s hospitals and emergency rooms.

For those facilities serving rural, hard-to-reach communities—which are often running on extremely limited resources as it is—these losses would be too much to bear. As a result, they could be forced to make tough decisions, including cutting back services, laying off staff, or closing their doors altogether. As many of these hospitals are the sole medical provider—not to mention jobs creator—for small towns and rural communities, these options would all be equally devastating.

Furthermore, a benchmarking approach to ending surprise billing would tilt the scales in favor of large insurance companies, not only giving them greater power to undercut provider payments, but also removing any incentive to negotiate fairly in order to bring more doctors into their networks. The latter should be a goal of any surprise billing legislation, as only by expanding provider networks can we help lower costs and increase access for patients.

There is hope, however, in the form of another legislative proposal that recommends the Independent Dispute Resolution (IDR) process. Unlike benchmarking, IDR would provide a reasonable solution for surprise billing that does not adversely impact patient access to care. Through an open, transparent process, IDR allows both insurers and providers an opportunity to negotiate out-of-network payment amounts in cases where disputes arise.

Under IDR, both insurers and providers would submit their best “offers” through an online process overseen by a third-party, independent mediator. Decisions regarding final payments would be made within 30 days and, until that time, an interim payment to providers would help ensure rural hospitals, in particular, remain stable and secure from a financial perspective. That, in turn, would help maintain access, quality, and affordability for patients in New Hampshire and across the country.

Ultimately, IDR is the only solution in Congress that will work—as it has proven to do so in New York, which passed a statewide bill implementing the process in 2015. Since then, network participation has increased, out-of-network bills have declined dramatically, and costs have remained stable.

As someone who has dedicated her career to serving Granite Staters, I am immensely grateful to Senator Maggie Hassan for supporting the proven IDR approach. I know she will work with Senator Jeanne Shaheen, as well as their colleagues in both the Senate and House, to pass final legislation that includes IDR to end the unfair practice of surprise medical billing for good.

Bette Lasky is a former New Hampshire State Senator, having served 4 terms. She retired from the senate in 2018.