- - Thursday, January 30, 2020

Americans have faced liens on their homes and sank under piling debt due to surprise medical bills. However, a plan introduced by Reps. Richard Neal, Massachusetts Democrat, and Kevin Brady, Texas Republican, could make surprise medical bills history and would prevent them from finding their way into the mailboxes of unsuspecting patients.

To be clear, these are high out-of-network medical bills that a patient receives after they were treated by a health care professional that was outside of their insurance network. The insurer doesn’t cover the bill, telling the patient that they’re on their own and have to pay for it themselves, since the doctor wasn’t in-network.

But this makes things tricky for patients. For example, a hospital might be within a patient’s network, but the physician who treated them might not be. So, even if a patient did their homework beforehand and chose an in-network hospital, they could still face a surprise bill.

And even if a patient made sure that the health care facility and physician were within their network, the patient can still receive a surprise bill from an out-of-network medical lab. For example, a patient received a nearly $18,000 bill for a urine test because the lab was outside of her insurance network.

Does any of this sound fair?



I think most people would say it isn’t — and Congress agrees. Now, Capitol Hill is weighing a variety of different options to address surprise medical bills. However, independent arbitration is the only solution to out-of-network bills.

Messrs. Neal and Brady are considering a plan to create an independent arbitration system in which doctors and insurance companies can settle out-of-network bills before an independent arbiter. Patients can relax knowing that they are covered and insurers would be held accountable. In other words, independent arbitration could put a real stop to this long-running insurance scam, in which insurers line their pockets at the expense of patients.

But other plans floated by some lawmakers hand more power to insurance companies and wouldn’t protect patients. Rep. Frank Pallone, New Jersey Democrat, introduced a plan that would allow the federal government to work with the insurance industry to unilaterally set medical rates. In other words, Congress is asking the same people who created the problem to fix it.

In fact, 81 percent of Americans blame insurers for surprise medical bills, yet, if Mr. Pallone’s bill passes, Congress would be handing them the keys to set their own rates. This would be unfair to patients and doctors, especially those in rural communities, where government rate-setting could wipe out hospitals and access to timely medical care.

If lawmakers let the government set fixed rates in a private industry, then Medicare for All would be a step away. Government rate-setting, after all, is the centerpiece of socialized health care.

On the other hand, independent arbitration restores fairness in the health care industry. Simply put, it is the best approach to ending surprise medical bills. But a combination of rate-setting and arbitration, like some are pushing for Messrs. Neal and Brady to accept, won’t end surprise medical bills. Without rate-setting, however, the Neal-Brady plan could be the solution that patients need.

Independent arbitration is a nonintrusive way to end one of the most intrusive problems facing patients. The method aligns with the values and legislative agendas of my own Sen. Cory Gardner and other conservative lawmakers, who have proven their support for patients and dedication to improving our health care system. By supporting independent arbitration, they could help end surprise medical bills — so that patients can rest easy.

• Kevin Priola is a small business owner and Colorado state senator. 

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