A recent report found that medical debt is the primary culprit for bankruptcy in America. Over 137 million Americans are struggling to pay their medical bills, causing many of them to go bankrupt. The number of people under crippling medical debt will continue to rise, unless lawmakers take action.
Contributing to rising healthcare costs are out-of-network charges, known as surprise medical bills. Patients receive surprise medical bills after they were treated at a hospital or by a doctor that was outside of their insurer’s approved network. In-network doctors and facilities have contracts with the patient’s insurer. When there isn’t a contract in place, insurers pass the bill to patients.
Essentially, this has become a loophole for insurers to renege on their responsibilities to customers. They don’t cover bills from out-of-network doctors and hospitals, leaving their customers responsible for thousands of dollars worth of medical care. At this point, what’s the point of paying for insurance?
You pay for insurance to, among other things, have your medical emergencies covered. And, let’s face it, when you’re in pain, you don’t have time to search every hospital in the area to find hospitals that are in-network. But even if you went to a hospital that is in your network, you could still be hit with a surprise medical bill.
In-network hospitals often have doctors who practice independently, so they have their own billing systems that are separate from the hospital’s. While the hospital accepts your insurance, the doctor might not. In other words, you can receive surprise bills from out-of-network doctors, despite being at an in-network hospital.
This is all too complicated. But it doesn’t have it to be like this.
The STOP Surprise Medical Bills Act (STOP Act), proposed by Sen. Bill Cassidy, R-La., would help end surprise bills. In emergencies, insurers would have to cover their customers when they are treated by out-of-network health care providers, such as hospitals and doctors. Patients are protected. And insurers are responsible for their end of the deal. It’s common sense.
And doctors are protected, too. For small medical practices that have to bill penny-pinching insurance conglomerates, there is a way for them to dispute unfair reimbursement payments. Under the STOP Act, they can challenge questionable bills and payments before an independent arbitrator. This part of the STOP Act makes it different from the other proposals that attempt to end surprise bills.
Rep. Richard Neal, for example, has proposed that the government set fixed rates for medical treatment. But this is a non sequitur and a distraction from the problem. It wouldn’t end surprise medical bills because it hardly addresses the issue.
Thankfully, many lawmakers dismissed Neal’s proposal and chose to support the STOP Act, which already has 13 Republican cosponsors.
But, in order for the STOP Act to pass, Sen. Cassidy will need more support from other Republican senators. Those known for championing healthcare reforms, such as Sens. Ben Sasse, Cory Gardner, among others, could help the bill pass Congress. Lawmakers tend to follow their lead on a number of issues—so with their support, the STOP Act can gain the momentum it needs.
Surprise medical bills have finally met their match. With the STOP Act, we can end surprise medical bills.
Jesse Grady is a former Texas Republican National Committee (RNC) staff member.