Commentary: State found way to stop surprise medical bills

Similar legislation in the U.S. Senate could save patients thousands of dollars in unexpected bills.

By Brad Forbes

For The Herald

Going to the hospital, particularly for an emergency, is always an uncertain and stressful experience.

For any patient, the whirlwind of doctors, nurses, tests and medical terminology can be overwhelming. It’s hard enough just getting through a hospital visit, let alone the sticker shock of getting an unexpected bill a month or so later. Surprise medical bills, when a patient is billed directly for charges they thought would be covered by their insurance company, happen more often than you might think. People with mental illness are particularly vulnerable to these types of charges.

While in the emergency room, patients can’t stop every specialist to quiz them about which insurance networks they’re a part of. Ultimately, this leads to patients being stuck in the middle with unpredictable out-of-pocket costs that can total in the tens of thousands of dollars. Given that health care debt is still the leading cause of bankruptcy for working families in the U.S., it’s important that we find a solution fast.

This past legislative session, Washington’s Legislature passed, and the governor signed into law, a solution that could serve as an example for how we solve this problem on a national scale. The legislation sets up a process for negotiation between clinical providers and insurers to figure out who gets paid what amount when out-of-network charges are incurred, without pushing these charges on to patients.

Washington isn’t the first state to pass this kind of surprise-billing legislation, sometimes called “Independent Dispute Resolution,” IDR for short. The state of New York in 2015 also opted for this particular pathway to address surprise medical billing, and the results are in: IDR works.

In the years since the New York IDR bill was signed into law, prices have remained relatively stable for common emergency room procedures, and some prices have actually lowered since 2015. In a short two years, the No. 1 out-of-network care claims dropped an astonishing 68 percent. That means insurance companies are now paying their fair share instead of being subsidized by patients’ pocketbooks, and that means more transparency and accountability in the system as a whole.

For patients managing mental illness, this is particularly important. People in a mental health crisis often need to see multiple providers as they stabilize, and do not have the opportunity to quiz each about billing. It is unrealistic to expect patients such as these, who may not be able to fully understand complex billing systems, to navigate provider networks and a psychological crisis at the same time.

The good news is, federal legislation has been introduced that could bring the IDR model to the whole country. The STOP – Surprise Bills Act of 2019 has significant bipartisan support with 23 co-sponsors in the Senate, and for good reason. Surprise medical bills are in important issue that touch all Americans, urban and rural alike. At a time when partisan politics in the other Washington seem more and more intractable, this is something we can all agree on.

I know Sen. Patty Murray, D-Washington, and her colleagues in the Senate still have a lot of work to do to find common ground on policy proposals that will make a substantive impact for people all across the country. I hope she finds a way to bring the successful IDR model onto the national stage.

Nearly two dozen Washington state health care advocacy organizations, including NAMI Washington, came together to help pass surprise billing legislation this year that has helped to protect patients, increase accountability and restore fairness to our health care system. We did so after careful consideration of the many competing options across the country and found IDR to be the one with the best track record of performance for achieving the goals we set out to accomplish.

Our state has always led the way on innovation in health care reform, and for the sake of patients and their families everywhere, I think it’s well past time for the other Washington to follow suit.

Brad Forbes is the director of public policy and advocacy for the National Alliance on Mental Illness’ Washington state chapter.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Opinion

toon
Editorial cartoons for Friday, March 29

A sketchy look at the news of the day.… Continue reading

Initiative promoter Tim Eyman takes a selfie photo before the start of a session of Thurston County Superior Court, Wednesday, Feb. 10, 2021, in Olympia, Wash. Eyman, who ran initiative campaigns across Washington for decades, will no longer be allowed to have any financial control over political committees, under a ruling from Superior Court Judge James Dixon Wednesday that blasted Eyman for using donor's contributions to line his own pocket. Eyman was also told to pay more than $2.5 million in penalties. (AP Photo/Ted S. Warren)
Editorial: Initiative fee increase protects process, taxpayers

Bumped up to $156 from $5, the increase may discourage attempts to game the initiative process.

Schwab: Who was Langerhans? And when’s the ferry to his islets?

The Herald’s resident retired surgeon slices into the anatomy of the etymology of our anatomy.

Comment: Cervial cancer treatable; if you’re screened for it

A screening for cervical cancer can detect cancerous or precancerous cells and direct treatment.

Comment: Framers gave us Goldilocks Constitution; let’s use it

It was meant to be resilient, not perfect, but it has to be used as designed toward workable solutions.

Comment: GOP in Congress isn’t fighting crime; it’s arming it

Budget cuts to the FBI and ATF and other riders have made it easier for criminals to get firearms.

toon
Editorial cartoons for Thursday, March 28

A sketchy look at the news of the day.… Continue reading

Washington state senators and representatives along with Governor Inslee and FTA Administrator Nuria Fernandez break ground at the Swift Orange Line on Tuesday, April 19, 2022 in Lynnwood, Washington. (Olivia Vanni / The Herald)
Editorial: Community Transit making most of Link’s arrival

The Lynnwood light rail station will allow the transit agency to improve routes and frequency of buses.

Protecting forests and prevent another landslide like Oso

Thank you for the powerful and heartbreaking article about the Oso landslide… Continue reading

Boeing’s downfall started when engineers demoted

Boeing used to be run by engineers who made money to build… Continue reading

Learn swimming safety to protect kids at beach, pool

Don’t forget to dive into water safety before hitting the pool or… Continue reading

An image of Everett Mayor Cassie Franklin is reflected in a storefront window during the State of the City Address on Thursday, March 21, 2024, at thee Everett Mall in Everett, Washington. (Ryan Berry / The Herald)
Editorial: State of city address makes case for Everett’s future

Mayor Franklin outlines challenges and responses as the city approaches significant decisions.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.