Linda J. Mason, M.D., FASA, submitted the following letter to the editor to the Wall Street Journal (WSJ) in response to a June 2019 article on out-of-network billing:
I appreciate Mr. Ippolito’s June 11 commentary (Get rid of surprise medical bills) where he suggests we need to do away with surprise medical bills, or as we refer to them, “surprise insurance gaps,” which are created when insurance companies, in exchange for low premiums, narrow the number of physicians included in networks.
As physicians our primary goal is to help our patients and keep them safe. We want patients to be protected from 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 10% of in-network hospital admissions resulted in an anesthesiologist’s out-of-network claim. But we remain committed to protecting all patients.
The American Society of Anesthesiologists has endorsed a comprehensive bipartisan proposal, “Protecting People from Surprise Medical Bills Act” as outlined by Congressmen Raul Ruiz and Phil Roe. This proposal puts patients first by holding them harmless from unanticipated bills. It also doesn’t pick winners or losers but instead places the dispute where it should be - between the health care provider and the insurance company.
Unfortunately, insurance plans often fail to create adequate networks of anesthesiologists and other physicians which is why patients experience surprise medical bills. Congressman Ruiz and his cosponsors’ proposal helps patients by providing greater transparency of their in-network providers.
Most importantly, the Ruiz-Roe proposal is based on the successful New York state model – a fully vetted, real-world functioning model that works. It is a solution with robust patient protections that removes patients from billing disputes, so they are responsible for nothing more than in-network copays and deductibles. It also creates a dispute resolution process to address physician and insurer disagreements, and payment guides based on the market, not inaccurate Medicare payments, which represent less than one-third of what is usually paid for anesthesia care. The New York model has been in place since 2015 and has reduced complaints related to surprise bills while saving health care dollars.
It’s a complicated topic, but the Ruiz Roe proposal is a legislative solution that will work for patients, providers and insurers.
Linda J. Mason, M.D., FASA
American Society of Anesthesiologists