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Find Cure To Surprise Billing

May 15, 2019 GMT

President Donald Trump called recently for an end to “surprise billing,” in which patients who think their treatments are covered instead are ambushed by large, unexpected bills. Congress, where there already is significant support to attack surprise billing, should heed the president’s call. There are two principal sources of billing surprises: • Emergency rooms. Injured or acutely ill patients often are covered for the emergency room visit, but often not for the services of a physician who is not in his insurer’s network. Those arrangements arise in as many as 20% of all emergency room cases. • Surgery. A patient often is covered for the services of the hospital and the surgeon, but not for other medical professionals on the case, most often an anesthesiologist or radiologist. There are several effective ways to address surprise billing. The law could require hospitals and physicians to bundle physician services into a single bill, much as nursing costs are included in the hospital’s bill. Some members of Congress want to cap charges by out-of-network physicians, but that would mitigate rather than resolve the problem. New York state has established a system by which out-of-network doctors are paid by the patient’s insurer through arbitration. That is closest to the best solution. State or federal law, or both, should require all medical providers to accept any valid health insurance, with a state-operated arbitration system to resolve disputes between providers and insurers. Fundamentally, a resolution requires making health care patient-centric rather than insurance-centric. A patient who pays for health insurance should not be ambushed for seeking needed medical treatment.