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Impartial Independent Dispute Resolution Needed for Surprise Medical Bills

By George LandrithWBAP

Impartial Independent Dispute Resolution Needed for Surprise Medical Bills

Large unexpected expenses are never welcome. No one likes a costly surprise. That may explain why Congress is talking about government imposing a “fix” to “protect” patients from surprise medical bills.

That may sound good, but healthy skepticism is warranted. One only needs to remember how the Obama-Biden administration repeatedly promised to save us all thousands of dollars every year and allow us to keep our health insurance and our doctor. None of that turned out to be true.

We need a solution to surprise medical bills that rescues consumers from being caught in between the doctor’s or hospital’s bill and the insurance company’s refusal to pay it. But we also need a solution that empowers consumers, not government bureaucrats, and that promotes innovation and harnesses the power of the marketplace to ensure high quality care at the lowest prices.

We must be 100% sure that we avoid government mandated procedures that effectively impose price controls because they also reduce the likelihood of future healthcare innovations and slow the development of promising medicines and procedures. Government mandates almost invariably shift power to government bureaucrats and health insurance companies, rather than giving consumers more control over their own healthcare.

The most common cause of a surprise medical bill is when a person uses a healthcare provider that is not in their insurance plan’s network of providers. While it doesn’t happen often, it is a real challenge for consumers when it does happen. Insurance companies have contracts with healthcare providers to provide medical services at discounted rates. That makes them “in-network.” The “out-of-network” providers charge a price without any pre-negotiated discounted rates. The problem arises when consumers get stuck between the insurance company that doesn’t want to pay and the doctor who should be paid.

The best way to solve the nation’s surprise medical bill problem is to implement a fair and open independent dispute resolution (IDR) process. A fair IDR process simply means that both sides of the out-of-network bill dispute, the physician and the health insurer, are allowed to submit all relevant information to make their case. Then the arbitrator or decision-maker can weigh the evidence and provide a fact specific resolution to what the insurance company should pay and what the doctor should accept.

This would relieve the patient of worrying about the bill, and it would make sure that difficult or complex medical procedures and treatments don’t become devalued or more difficult to find.

Sens. Lamar Alexander and Bill Cassidy are rumored to be working on a “compromise” that purports to use a form of IDR. But we should be on high alert because all indications are that the “compromise” will include a rigged or sham IDR process that puts the heavy hand of government on one side of the scales of fairness and justice. There is no reason to use a process that from the start tips the scales in favor of either the doctor or the insurance company.

This “compromise” will favor insurance companies over doctors. If the government-imposed process ends up being a price control system, it will simply be a step toward socialized medicine and will make finding doctors to treat you more difficult. What we should all want is a fair and balanced process.

A fair and impartial IDR process that resolves the pricing dispute would prevent the consumer from getting caught in the middle. It would also empower consumers, not government.

Additionally, it would harness the power of the marketplace to keep quality up and prices down. It is important to remember that government regulations don’t have a track record of reducing costs. Moreover, government mandates will do nothing to reward innovation, or to empower consumers.

Regardless of what their true motives were or are, the results we have witnessed in the last 50 years from politicians promising “fixes” has been that things end up costing a lot more than promised, and government gets more and more control. Those who can afford lobbying efforts may escape the costly impact of these government mandates. But rarely do these promised fixes on balance help the average citizen.

Instead of continuing to empower government, insurance companies, and those who can afford lobbyists to protect their interests, let’s try reforms that put economic power back in the hands of healthcare consumers. Let’s trust the marketplace to do what it does so well — boost quality and keep prices comparatively low. We trust the marketplace to provide us with food, housing, technology, and thousands of other very important things. Why not our healthcare, as well?

We can do all of this with a fair and balanced IDR process that allows both sides of the out-of-network bill dispute to submit all relevant information to make their case. If this happens, we protect consumers from surprise medical bills and we keep burdensome government mandates out of our healthcare choices. That’s a win-win!


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