A Practical Solution is Needed to End Surprise Billing 

A “surprise bill” happens when the doctor and insurer disagree on the payment, and the patient is billed for the difference. (Photo by DNY59/Getty Images)

By Nick Hill, Executive Director, Kern County Black Chamber of Commerce

Letter to the Editor

As summer winds down, members of Congress will soon be returning to session. Once there, one of the biggest issues they have yet to tackle will be ending surprise medical billing. While they have a good start already—with several proposals on the table—it is important they get the job done right. That means avoiding any solutions that could unintentionally make things worse for patients in Kern County, throughout California, and across the country.

Surprise medical billing is an issue with no party preference—so it’s important that Congress enact a bipartisan approach to protect patients from the undue stress and anxiety these unexpected medical costs can create. No one recovering from medical treatment should need to worry about getting hit with surprise medical bills and being caught in the crosshairs of billing disputes between our physicians and insurers.

That’s why Congress needs to act—but act carefully so as not to make matters worse, especially in communities where large, unexpected bills can be devastating. Sadly, some of the measures that have been introduced in Congress would do precisely that—particularly ones that call for an insurance-controlled benchmark to determine physician rates.

This proposed “benchmarking” approach would put bureaucrats in charge of setting rates paid to physicians here in California and nationwide. This creates a one-size-fits-all system, slashing reimbursement rates to physicians to the point where our local hospitals and emergency rooms would suffer huge financial losses. In turn, these losses would undermine their ability to provide quality care, forcing them to cut back services or eliminate staff. They could even be forced to consolidate or close down completely. Once again creating care gaps in the healthcare system, something which disproportionately impacts communities of color.

For patients in Kern County—including many Kern County Black Chamber of Commerce (KCBCC) members—accessing quality, affordable health care is difficult enough. Too many communities served by the KCBCC already lack sufficient health care options. Further undermining access and affordability would be a burden that could be too great to bear. Benchmarking is quite simply not a workable solution.

Instead, Congress should keep its sights on other proposals that outline a far more effective approach to resolving payment disputes between providers and insurers: Independent Dispute Resolution (IDR). Unlike benchmarking, IDR would protect patients from surprise billing while maintaining access and affordability.

IDR creates a framework for fair, transparent negotiations—overseen by an independent, third-party mediator—so insurers and physicians could settle payment disputes openly and transparently. The process would take place entirely online and, until a final payment amount has been decided by the mediator, providers would receive an initial payment that would help keep hospitals in underserved areas financially stable to preserve patient access to care.

This is the far better solution for Californians and all Americans. Rep. Kevin McCarthy has always looked out for the well-being of his constituents, and now as the Minority Leader in Congress, I trust that he will do what’s right by supporting a commonsense approach to protecting patients. That means championing IDR, and working with his colleagues to include it in any legislation Congress passes to solve this problem of surprise medical billing.

Nick Hill is the Executive Director of the Kern County Black Chamber of Commerce.