Can Socialists Save Us from Surprise Medical Bills?

"Surprise billing" is the latest health care crisis, and it has prompted the usual response: big government to the rescue.

Balance billing — or a surprise medical bill — happens when you get a bill from a doctor, hospital, or other health care provider who isn't part of your health plan's network of physicians, hospitals, and other health care providers.  Your health plan is your health insurance.

Surprise billing occurs because insurance plans can't create coverage for all the providers you might see in their promises to insured, and insureds don't get a proper warning about the impact of bills from out-of-network doctors and hospitals that aren't under agreements for fees with the insurance plan.  Most insurance/network plans don't get the high-dollar and high-expertise providers to agree to their fees, which are pretty modest (often chintzy), so most insurance plans with "networks" sell a shabby product to the public without warning that they are not comprehensive and leave a lot of gaps that are filled by specialists and other providers who don't agree to the insurance plan "network" fee schedules.

For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network emergency physician or an out-of-network consultant called in.  The doctors and the hospital each bill $1,000 for their services, and the health plan pays them each $400 based on the network health plan fee schedule. The in-network hospital accepts the $400, but the doctors may bill for the balance of the bill, $600 that the health plan insurance didn't pay.  That begins the patient insured's anxiety and frustration, maybe even referral to collections and compromise of credit status as a deadbeat.  Nowhere in the mix is the original insurance company trying to settle up with the out of network providers — it's the patient, or the responsible party, on his own.

Senator Lamar Alexander, who has never seen a government intervention he didn't like, proudly announced recently that the Senate is coming to the rescue to fix a problem with health insurance coverage on surprise billing with a new law — last month, the Senate's health committee passed the "Lower Health Care Costs Act," by a vote of 20-3...and the grateful citizens breathe a sigh of relief?  States like Ohio and Texas have also passed laws to force "out of network" physicians and hospitals to accept "negotiated" fees based on market averages or medians or some other imposed standard for charges that is often determined by or heavily influenced by the insurance industry.