Thursday, December 12, 2019


Seniors visiting a hospital or urgent care center have run into a big problem in recent years — surprise medical bills. A surprise medical bill happens when a senior receives treatment at an “in-network” facility only to find that a specific medical practitioner who provided a service — a lab, an anesthesiologist, a physical therapist — is “out-of-network” and not covered by insurance. 

This is justifiably outrageous for older Americans, who are the biggest users of hospital care by far. Seniors want to know who is going to fix this problem and Washington tends to blame the out-of-network providers. Rather, it’s the job of the insurance company to make sure that when they tell a senior that a hospital or other facility is “in network,” that it truly is. Patients should be able to check into a hospital that an insurance company says is in-network with the expectation that their care is covered by insurance. 

Big Insurance sees it differently. Rather than working out a better system to guarantee in-network status at hospitals or figuring out a way to reimburse providers who are out of network without burdening patients with surprise medical bills, insurance lobbyists want Congress to impose price controls. The insurance industry seems to think that having Congress dictate how much the anesthesiologist can get reimbursed is a better solution than simple transparency. It’s not. 

If Congress takes no action, insurance plans will continue to send giant surprise medical bills to seniors, and will point the finger at Congress for refusing to act. Seniors would be used as political pawns in a high stakes Beltway game of chicken. It’s wrong, and Big Insurance needs to be called out for their reckless behavior. In no event should Congress cave to the demands for price controls.

Price controls would be very bad for seniors and everyone else. If doctors, labs and other medical specialists could only charge a certain amount to insurance companies by law, many of these professionals would retire early, sell their practice or scale back their hours. That means fewer medical services for the people who need it most, not to mention that older Americans will have longer wait times for care. 

The inevitable result would be the rationing of health care. Since we’re dealing with older people approaching the end of their lives, seniors would face cold-blooded cost-benefit analyses that determine who receives treatment and who doesn’t; who lives and who doesn’t. It’s death panels all over again.

There are no easy fixes for surprise medical billing. The best solution would involve minimal government interference and maximum transparency, combined with honest negotiations between hospitals, insurance companies, medical providers and patients. 

We should be able to agree that a patient who did the right thing and went to an in-network facility should be held harmless from surprise medical bills. It’s not fair, and neither is Congress relieving Big Insurance of their obligation to help figure out this tricky public policy challenge.

• James L. Martin is the founder and chairman of the 60 Plus Association, and Saulius “Saul” Anuzis is president.

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