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ASA President Linda Mason, M.D., FASA, sent the following letter to the editor to the Wall Street Journal (WSJ) in response to an April 2019 article on out-of-network billing:
I appreciate Stephanie Armour’s (Congress Looks to Tackle Surprise Medical Bills, 4/2/2019) attempt to explain the issue of surprise medical bills, or as we refer to it, “surprise insurance gaps,” when a patient is surprised to learn that their physician is not in their insurance plan.
Our primary goal is to help our patients and keep them safe. We want patients to be protected from these unanticipated bills. Fortunately, most physician anesthesiologists want to be and are in their patient’s insurance plans or “in-network.” A recent study found that less than 1 in 12 in-network hospital admissions resulted in an anesthesiologist’s out-of-network claim.
It’s important for patients and Congress to also understand that insurers have an important role to play in addressing this issue. These plans often fail to create adequate and accessible networks of anesthesiologists and other physicians. Just last year, Texas anesthesiologists successfully challenged a health plan for failing to maintain appropriate networks for over 200 health care facilities. The Texas Department of Insurance fined the plan $700,000.
The American Society of Anesthesiologists supports solutions that protect patients, assure adequate physician networks and provide patients with the information they need to understand their plans. Congress should look to the successful New York state model, where patients are responsible for nothing more than their in-network copays and deductibles, where a dispute resolution process was created to address physician and insurer disagreements, and payment guides are based on the market, not inaccurate Medicare payments, which represent less than one-third of what is usually paid for anesthesia care.
It’s a complicated topic, but we agree with Congress that finding a solution is an important priority and if we all work together, it can be accomplished.
Linda J. Mason, M.D., FASA
President
American Society of Anesthesiologists
Schaumburg, Illinois
