How to End Surprise Billing Without Threatening Access to Care for Seniors, Rural Patients

For seniors and others living on fixed incomes, keeping up with the rising costs of health care and prescription drugs is difficult enough. Surprise billing—which happens when patients, often unknowingly, receive out-of-network medical care and are later hit with astronomically high bills for the cost of care not covered by insurance—only makes the situation that much worse.

It is well past time for Congress to address this issue at the national level as this is an issue that impacts patients across the country. However, as our members of Congress work to implement the best possible solution for this growing problem, they must be sure that whatever legislation they pass does not have any negative, unintended consequences for patients, especially those living in rural areas where access to quality health care is already limited.

The Problem with Benchmarking

A particularly risky proposal called benchmarking has the American Senior Alliance concerned. Benchmarking would permit the federal government to set out-of-network payment rates for physicians by using insurance companies highly discounted in-network averages as a guide.

By setting artificially lower rates for physicians, benchmarking would:

  • Transfer significant financial losses onto local hospitals, emergency rooms, and other health care facilities, many of which are struggling just to get by.
  • Force many rural hospitals and emergency rooms to scale back their services, lay off much-needed staff, or even close down altogether.
  • Contribute to our nation’s growing doctor shortage and increase the already high rate of provider consolidation, especially in rural communities.
  • Make it that much harder for seniors and rural patients to access the care they need at prices that won’t break the bank.

Often, emergency rooms serve as the primary point of care for America’s seniors and rural patients, especially in a state like Alabama. Undermining access and driving up costs at these facilities would be devastating for some of the most at-risk patients here and throughout the nation.

The Right Path Forward

Fortunately, a far more effective solution for surprise billing can be found in an approach called Independent Dispute Resolution (IDR). Under IDR, patients would be protected from surprise medical billing and only held accountable for their in-network cost sharing amounts—all without jeopardizing rural health care access, affordability, or quality.

The IDR process is simple, effective, and fair. Here’s how it would work:

  • Both providers and insurers submit their best payment offer through an online portal.
  • An unbiased, third-party mediator would review these offers as well as a number of factors and independent data.
  • Within 30 days, the mediator would determine a final payment amount based on the true market value of the services provided.
  • In the interim, initial payments to providers would help ensure financial stability and security for struggling hospitals and emergency rooms serving our rural communities.

Ultimately, IDR is the right path forward to eliminate surprise medical billing without disrupting health care for America’s seniors and rural communities. Representative Terri Sewell and the rest of Alabama’s elected members of the U.S. House and Senate should oppose benchmarking


get updates