Letters: Readers weigh in on solving balancing billing issues

The April 8 editorial, “A simple solution to a complex problem: Ban balance billing,” relies on flawed studies to blame emergency department staffing firms for the surprise gaps in health insurance that leave patients paying out of pocket for care. 

However, surprise gaps in health insurance have become a regular part of American life because large commercial insurance companies have significantly narrowed their coverage networks, forcing more doctors and patients out-of-network. The result is inadequate insurance coverage that leaves patients exposed to high out-of-network deductibles that can sometimes be upward of $8,000. 

Even after a patient’s deductible is met, insurers will reimburse physicians significantly below the usual and customary rate for out-of-network care, leaving physicians to either seek reimbursement directly from patients in the form of a balance bill or accept pennies on the dollar from insurance companies. 

It would be unacceptable to put the quality and accessibility of our emergency departments at risk by allowing the insurance industry to have unilateral control over reimbursement rates for out-of-network emergency care. Even though emergency physicians make up only 4% of all physicians, they provide more than two-thirds of uninsured care and over half of Medicaid and CHIP care, thus disproportionately forming the primary safety net for the U.S. healthcare system.  

Congress should take patients out of the middle by requiring insurers to contribute equitably to out-of-network care. They can do this by using an independent, data-based benefit standard for “covered” out-of-network emergency care that not only sustains the nation’s healthcare safety net but will also take patients out of the middle. 

A comprehensive solution that prioritizes patient interests over profits will recognize the importance of using an appropriate reimbursement methodology that protects access to emergency care, while also protecting patients from surprise gaps in their health insurance.

Dr. Andrea Brault
Board chair
Emergency Department Practice Management Association

Regarding the April 8 editorial, “A simple solution to a complex problem: Ban balance billing,” in the ongoing cost debate, one thing is clear: Patients deserve to be taken out of the middle and provided with a clear framework that outlines the roles and responsibilities of insurers, hospitals and physicians in the delivery of out-of-network emergency medical care. 

Banning surprise billing without establishing an alternative dispute resolution process and without decoding the billing process would fail to solve the systemic issues that lead to gaps in insurance coverage and the subsequent surprises when patients receive bills that are higher than they expected because services were not covered by insurance.

Currently, patients are underinformed about their rights as patients and as healthcare consumers—which are often at odds. As a patient, an individual is guaranteed the right to crucial, life-saving medical services. As a healthcare consumer, an individual is not entitled to free services. In addition, the Emergency Medical Treatment and Labor Act dictates that every person has the right to receive medical treatment in an emergency and that hospitals must care for patients who enter their doors. The government has not provided hospitals or physicians financial support to execute this regulation since its enactment in 1989. Still, healthcare providers care for every patient who enters their doors per EMTALA—thus serving as the safety net.

Solely banning surprise billing and leaving hospitals, physicians and insurers to “sort it out” would not alleviate the imbalance of power, improve transparency or limit a patient’s financial responsibility. Instead, Congress must establish an alternative dispute resolution process that brings insurers, physicians and hospitals to the table.

Bob Kneely
Senior vice president of marketing, communications and government affairs
Envision