Baystate Health President & CEO Mark A. Keroack, M.D., and the President of the Hampden District Medical Society Subramony Subramonia-Iyer, M.D. penned an
op-ed last week in the Springfield Republican explaining why the “surprise medical billing” solution being championed by U.S. Representative Richard Neal (D—Mass.) deserves praise.
Surprise medical bills occur when a patient unknowingly receives medical services at a location, or from a clinician, outside of the patient’s insurance network. Hospitals believe patients should never receive a surprise bill and should only be responsible for what they would customarily pay for in-network care as specified by their insurance policy. The thorny question is how to reimburse the out-of-network care.
Neal, as chair of the Ways & Means Committee, has promoted a solution whereby insurance companies and healthcare providers can first try to work out differences. If an agreement can’t be reached, the proposal calls for an impartial structured process to settle payment. Hospitals favor such a “baseball-style” arbitration process. If the provider and insurer cannot reach resolution on a payment amount, each side brings their “last, best offer” to the table. The arbiter picks one of the two offers and there is no middle ground.
“The Ways & Means proposal provides important protections and transparency for patients without undue government interference in private contracts,” Keroack and Subramonia-Iyer wrote. “It is directly responsive to the priorities of the hospital and physician communities and deserves widespread support. We commend Representative Neal for his extraordinary leadership on this issue.”