‘Surprise Billing’ Laws Will Gut Emergency Care


Congressional Republicans, led by Sen. Lamar Alexander (R-Tenn.), are reportedly attempting to tack a “surprise billing” provision onto a “must pass” spending deal. This amounts to federal price-fixing, states the Association of American Physicians and Surgeons (AAPS). It protects insurers against having to pay a market-determined price for services, but endangers patients.

“It should not be a surprise that skilled physicians who get up at night or interrupt their schedule to care for you need to be paid,” states AAPS executive director Jane M. Orient, M.D. “What surprises patients is that their insurance company, which collects outrageous premiums month after month, doesn’t pay the bill.”

Patients who receive care at an in-network hospital expect that they will pay a copay or deductible and that the insurer will pay the negotiated in-network fee, Dr. Orient explained. What they don’t know is that the network may be very narrow so that the doctor they need is excluded, or that the insurer’s contract is so oppressive that physicians decline to participate. So, the choices are between an out-of-network doctor, delayed care, or care from a less-skilled practitioner. Also, there may be a separate, much higher deductible for out-of-network services.

“Balance billing” is for paying the bill that the insurer doesn’t pay. How much should the bill be? Should the insurance company decide? The federal bureaucracy? The federal government has been imposing price controls in Medicare and Medicaid for decades. Most people expect a cost-of-living increase each year; doctors routinely get a cost-of-living decrease as their overhead costs mount, Dr. Orient states.

In fact, “In 2019, doctors are essentially being paid [by Medicare] at the same rate per unit of work as they were in 1998, despite general inflation of more than 50 percent over that period,” reports the American College of Surgeons.

“If price controls are expanded to all medical services, more and more doctors will retire early or change their occupation,” Dr. Orient stated.

“Balance billing under Medicare and some state laws is allowed only for nonurgent, elective services,” she notes. “This means you are not allowed to pay for timely services you desperately need. You only get those that are still available at the government-set price. You can, however, still buy a tummy-tuck.”

Outrageous bills do occur. “Mostly these are from ‘nonprofit’ hospitals, not from independent physicians. There are many possible remedies. Strangling the medical economy with price-fixing only creates worse problems,” Dr. Orient warned.

AAPS is encouraging physicians to contact their Members of Congress: https://aapsonline.org/contact-congress-about-dangers-of-proposed-fix-for-surprise-bills/

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties since 1943.