Ideas to Curb Surprise Medical Bills Percolate with Rare Bipartisan Push

I'd be really happy to see surprise billing come to an end. I'm not sure there's a good of way doing it, though. There's a fundamental tension:

(1) People often need care quicker than their financial and insurance situation can be established. Insurance companies love to deny claims retroactively, which by definition won't hit people until well after necessary care has been provided. Requiring pre-authorization for everything from insurers is a huge problem, in terms of time, illegitimate denials, and the amount of overhead it creates for providers (having to hire staff just to sit on the phone with insurers all day.)

(2) This creates an incentive to provide minimal care to folks. If the provider or hospital is left entirely on the hook for eating the cost of a denied claim, and can't ethically deny care, the result is going to be pretty much everyone getting the same care that homeless folks coming in off the street get: absolute minimum care necessary to stabilize, then get out. Go spend a week sorting out your pre-authorizations, and then come back. This is the effect you'd get from the Cassidy bill, Hassan, or Doggett.

(3) This creates a serious amount of leverage for insurers. Right now, part of what keeps insurers at least somewhat in check is that providers refusing to participate in their networks requires insurers to negotiate reimbursement rates to attract physicians, in order to attract patients. Patients won't go to out-of-network providers due to the expense. In this instance, the insurer can cut back on the number of providers in their network. Patients will avoid out of network care as long as they can, eventually present in an emergency, and score in-network prices anyway - which means the insurer gets to pay for fewer visits at reduced costs, while being able to negotiate reduced reimbursement rates all around.

Every single one of these proposals basically says "if anything happens, the provider eats it." There's not a single mechanism included to share the "eats it" with the insurer, or to prevent insurer abuse. This creates a major incentive for insurers to game the system to shift their costs to providers, by aggressively denying even more claims, knowing that there won't be any consumer backlash for it.

Part of this has to do with trying to protect emergency coverage. I think the ACA already covered this reasonably well, and it's just a clause that needs to be vigorously defended: all emergency room care is in-network, period. But this was laid at the feet of insurers. I'm somehow less than shocked that the new round of bills seeks to shift the entire burden, emergency or not, from insurers to providers... despite the fact that the "surprise" component of surprise billing is almost entirely a function of insurer behavior.