Nearly two years after I wrote a column about balance billing, the nation still wrestles with how to best solve this complex problem with a simple yet fair policy solution.¹ Most physicians understand what a “surprise bill” is by now, but members of the media and the public have been repeatedly confused by the insurance industry’s clever marketing of the term—lumping in not-so-surprising out-of-pocket costs such as copays and deductibles, items that are expected as part of standard health insurance contracts.

The narrative, driven by calling out profit-hungry motives of certain players in the health care industry, provides fodder to the assertion that patients should be taken out of the middle of disagreements between insurance companies and physicians over reimbursement. ACEP agrees with the idea that patients should be out of the middle of these ongoing disputes.

Three potential solutions, two of which are currently under consideration in the U.S. Congress, have been proposed to deal with surprise billing. The first, a benchmarking approach that places decision making with insurance companies or government regulators, has been tried in California and is the topic of this month’s Health Policy Journal Club. The second, network matching, would require physicians at in-network facilities to accept the same insurance plans as the facilities in which they work do, ultimately removing leverage from doctors and shifting it to hospitals. The third, baseball-style arbitration, would permit a neutral third party to decide which player in the game—the insurer or the physician—has an offer closer to the realistic market value of emergency services. This approach has been enacted in blue states like New York and red states like Texas.

After studying this issue for many years, I feel the best solution is a matter of perspective and an honest appraisal of the tradeoffs. No matter what is chosen, patients win, but in my view, benchmarking can become overly generous to insurance companies. Perhaps that is why a set of strange bedfellows ranging, from Al Sharpton to the Cato Institute and from the Hispanic Leadership Fund to swing state voters, have all opposed benchmarking.^2–5 My opinion is that arbitration, the strategy put forth by the House Ways and Means Committee and the one most fair to the doctors toiling on the front lines of America’s emergency departments, is the optimal solution.

Dr. Dark is assistant professor of emergency medicine at Baylor College of Medicine in Houston and executive editor of PolicyRx.org.

References

1. Dark C. A fair price in an imperfect market. ACEP Now. 2018;37(10):42-44.
2. Sharpton A. Why I came to Charleston. Morning Consult website. Feb. 20, 2020. Accessed July 24, 2020.
3. Brannon I, Kempe D. The potential pitfalls of combating surprise billing. Regulation. 2019;42(3):40-45. Comment 45-47.
4. Lopez MH. ‘Fixing’ the problem of surprise medical bills must not harm Medicare and Medicaid. The Hill website. April 3, 2020. Accessed July 24, 2020.
5. Easley J. Swing-state voters oppose ‘surprise’ medical bill legislation, Trump pollster warns. The Hill website. Sept. 17, 2019. Accessed July 24, 2020.