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.