The Coalition Against Surprise Medical Billing is proud to be one of the strongest voices calling on policymakers to take urgent action to protect patients from unfair and unreasonable surprise medical bills. These egregious charges from out-of-network providers at in-network facilities have been haunting – and hurting – American families for far too long.
While the need for reform is obvious, how Congressional leaders and the Trump administration go about curtailing surprise billing is a critical question.
Congress is currently exploring two ways to determine how much to reimburse out-of-network providers and clinicians, as part of the broader reform to end surprise medical billing. One way would require health insurance providers to reimburse out-of-network providers based on a fair benchmark standard that reflects the actual cost of care provided in their communities. The other would mandate an expensive and bureaucratic arbitration process between health plans and the subset of providers who insist on remaining out-of-network.
We’ve already told you about arbitration, and the details are not encouraging.
Arbitration is an expensive, time-consuming, and convoluted process that does nothing to address the real problem: the surprise medical bill itself. These shocking surprise bills can be as much as 5.8 times the rates charged by the vast majority of doctors who participate in networks. There is no justification for egregiously overcharging patients and taxpayers like this.
But what about the alternative?
While a “fair benchmark standard” may sound wonky, in reality it’s a straight-forward, common-sense, and meaningful reform. It would provide safeguards for patients and their families during health emergencies while ensuring that providers are reimbursed at a fair, market-based rate.
This provides a crucial distinction from the arbitration process. Arbitration rewards out-of-network providers by treating their exorbitant charges as equivalent to reasonable market-based rates during the negotiation process.
A fair benchmark standard, by contrast, ensures fair and equitable treatment for health care providers, consumers, employers, and taxpayers. It sets a rate that is tied to existing in-network market rates – and even takes into account geographic cost differences. That means communities have the flexibility to use locally-negotiated rates, which are especially important for the small and rural hospitals that play such a vital role for the families they serve.
Alright, so maybe that is still a bit wonky. The end result, however, is easy to understand.
According to a recent estimate from the non-partisan Congressional Budget Office (CBO), implementing a fair benchmark standard could save consumers and taxpayers more than $25 billion over ten years. Those are savings that would ultimately reach consumers in the form of lower premiums.
The takeaway is clear.
Introducing a fair benchmark standard would protects patients, ensure fairness for providers, and put an end to surprise billing the right way. Arbitration would just encourage more of the skyrocketing medical bills that got us into this mess in the first place. If the CBO report underscores anything, it’s that while the need to end surprise billing is urgent, there is too much at stake to rush through with short-sighted “solutions,” such as arbitration.