Medical care can be hard enough without having to deal with unexpected bills for out-of-network care. Employers rely on health insurance networks to keep coverage more affordable. But some medical providers (particularly anesthesiologists, pathologists, radiologists and stand-alone emergency rooms) insist on staying out of network, pocketing the health plan reimbursement as well as billing the patient for big additional sums based on the provider’s list prices. These huge bills — often pursued by bill collectors — add financial insult and misery to medical care.
A fair solution should protect patients from surprise bills and limit out-of-network providers to a fair and reasonable reimbursement. A benchmark rate based on local provider charges will fairly compensate providers. Congress should reject the idea of adding arbitration as an unnecessary and time-wasting means of resolving reimbursement disputes.