Guest Blog- Sen. Chuck Winder & Rep. Megan Blanksma – We Need Medical Billing with No Surprises

Medical bills are high enough without surprise bills that can be astronomical, but that’s exactly what some Idahoans are forced to deal with. People are being saddled with huge debt for out-of-network care, even after they go to an in-network facility and doctor. It’s not right, and it’s why we need to pass the No Surprises Act to protect patients.

Health care costs continue to climb at a steep and relentless rate. Idahoans are struggling to afford their insurance premiums, let alone the deductibles and out-of-pocket costs. That’s why people are careful to choose an insurance plan that meets their needs and facilities and physicians who are contracted with their insurance company. In fact, almost 98 percent of the time people choose contracted facilities and physicians. Yet, they still might get stuck with out-of-network costs.

Here’s how you can get blindsided by surprise medical billing from a few health care providers. If you needed care, you would likely be careful and go to an in-network hospital for care. But, while you’re there, you could get supplemental care from specialists in areas like anesthesiology, radiology, or pathology. Some of those providers have not contracted with your insurance plan, let alone with you directly. That means, weeks later, you would get a huge bill in the mail for those out-of-network services, when you thought everything at the hospital was in-network. While these surprise bills come from a very small number of physicians (over 95 percent of providers contract with the four largest insurance carriers in Idaho), they are all too common for the families who see their budgets destroyed.

The solution is the No Surprises Act. The bill would require compromises from insurance companies and providers. Insurers would treat providers who are not contracted as if they were, paying them the higher contracted rates and providing the member in-network benefits. The provider, in turn, would have to accept these payments from the insurance company as their total payment, and not bill the patient for any additional charges. That’s piece of mind for all of us.

Why do some noncontracted providers charge more? They want more fees than 95 percent of the contracted physicians in the state, sometimes charging as much as 5 to 12 times what Medicare would pay. This is not the Idaho way. The No Surprises Act would remove the incentive for these providers to take advantage of Idaho patients, protecting your financial well-being.

The No Surprises Act would protect the freedom of doctors to choose where to practice and who to accept as new patients. But, when they do practice in a contracted facility, it would also protect your finances, as the patient. Health care is expensive, with premiums, facility charges, and the primary physician’s fee. This bill will make sure no surprise charges are piled on top of that. The No Surprises Act is one way we can battle back against the rising cost of health care.

-Senate Majority Leader Chuck Winder and House Majority Caucus Chair Representative Megan Blanksma