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How We End Surprise Medical Billing

posted by AHIP

on March 3, 2020

Anyone who has received a surprise medical bill knows the feeling of dismay when opening the letter from an unknown provider and seeing an outrageous charge. No one should ever face a surprise medical bill that can lead to financial ruin. Yet millions of patients who do everything right face surprise medical bills they did not expect at prices they cannot afford.

While most doctors and providers do their best to deliver fair, affordable care for patients and their families, a small but significant number of doctors and hospitals—many owned by private equity firms—are responsible for the majority of surprise medical bills. And they are spending millions to defend a business model that price gouges millions of Americans.

When clinical specialists choose not to participate in health insurance providers’ networks—or if they do not meet the high standards for inclusion—they often demand a blank check from patients for their services. The consequences are significant: financial stress; fighting a complicated, confusing bureaucracy; harassed by collection agencies; and often legal action for non-payment. And their outrageous prices lead to higher health insurance costs for everyone.

Unlike any other player in the health system—including doctors, hospitals, Big Pharma, or private equity—health insurance providers’ are accountable for their prices and costs. Our industry spends at least 80-85 cents of every dollar on health services like hospital stays and prescriptions for the Americans they serve. The remainder pays for things like fraud, waste, and abuse prevention, nurse hotlines, process provider payments, consumer support tools and clinical excellence programs – as well as to pay employee salaries and benefits and pay state and federal taxes.

Any real solution to surprise medical bills must protect patients when they need emergency care and establish a fair, market-based benchmark based on locally negotiated rates to stop abuse of the system by some providers.

The good news is we can solve this challenge for the American people. Health insurance providers stand ready to work with providers and others to deliver real solutions.

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