A legislative policy known as surprise medical billing enables healthcare providers to bill patients for services not previously disclosed or anticipated, especially when out of their network. The negative impact of this policy on patient care and healthcare and the financial burden it places on patients has been criticized. The following discussion will thoroughly examine the detrimental effects of surprise medical billing and offer recommendations for policy improvements.
Surprise medical billing can lead to financial hardship for patients, as they are left with substantial bills they were not expecting. Cooper et al. (2020) have provided an example where patients may incur unexpected medical bills for receiving services from an out-of-network anesthesiologist during a surgical procedure at an in-network medical facility. This financial strain can result in patients delaying or avoiding necessary medical care, ultimately leading to poorer health outcomes (Garmon & Chartock, 2017). One study found that every fifth inpatient emergency department case is likely to end up with a surprise bill (Garmon & Chartock, 2017). From a biblical worldview, this policy contradicts the principle of compassion and care for others, as it burdens vulnerable individuals unnecessarily (Bible Gateway, 2023, Proverbs 22:22-23).
Moreover, surprise medical billing impacts patients and increases healthcare costs overall. Insurers may pass on these additional costs to consumers through higher premiums or reduced benefits, further exacerbating the financial burden on patients (Hyman et al., 2019). According to Cooper et al. (2020), the fees for out-of-network billing can be almost 2.5 times higher than the charges for the same services within a network. This cost variation contributes to the overall rise in healthcare expenses and places additional pressure on insurance companies and patients.
Several recommendations can be considered to address the surprise medical billing issue. First, the policy should require healthcare providers to disclose out-of-network charges to patients before services are rendered (Lieneck et al., 2023). This would ensure that patients know potential costs and can make informed decisions about their care. For example, providers could be required to obtain written consent from patients acknowledging the out-of-network charges before proceeding with treatment.
Second, a cap should be placed on out-of-network charges to prevent excessive fees. This would protect patients from incurring unreasonably high costs for services they could not have anticipated (Hyman et al., 2019). Policymakers could establish a maximum allowable charge for out-of-network services based on a percentage of Medicare reimbursement rates or the average in-network rate for similar services. Lastly, state and federal regulators should work together to create a standardized system for settling payment disputes between insurance companies and medical institutions. This would streamline the process and alleviate some financial stress on patients (Cooper et al., 2020). Potential solutions include mandatory arbitration or establishing an independent dispute resolution process.
In conclusion, the legislative policy on surprise medical billing hurts healthcare and patient care. This issue can be addressed by implementing policy revisions or replacements, ultimately leading to better healthcare outcomes and reduced patient financial burdens. Policymakers must act promptly and decisively to protect patients from the unintended consequences of surprise medical billing and promote a more equitable healthcare system.
References
Bible Gateway (2023). New International Version. biblegateway.com. Web.
Cooper, Z., Nguyen, H., Shekita, N., & Morton, F. S. (2020). Out-Of-Network Billing And Negotiated Payments For Hospital-Based Physicians: The cost impact of specialists who bill patients at out-of-network rates even though the patients do not choose and cannot avoid these specialists, such as anesthesiologists. Health Affairs, 39(1), 24-32. Web.
Garmon, C., & Chartock, B. (2017). One in five inpatient emergency department cases may lead to surprise bills. Health Affairs, 36(1), 177-181. Web.
Hyman, D. A., Ippolito, B., & Silver, C. (2019). Surprise medical bills: How to protect patients and make care more affordable. Geo. LJ, 108, 1655.
Lieneck, C., Gallegos, M., Ebner, M., Drake, H., Mole, E., & Lucio, K. (2023). Rapid Review of “No Surprise” Medical Billing in the United States: Stakeholder Perceptions and Challenges. Healthcare 2023, 11, 761. Web.