Arbitration process would fix problem of surprise medical billing

September 10, 2019
Burchett Opinions

Arbitration process would fix problem of surprise medical billing

This article was originally featured in the Knoxville News Sentinel on September 10, 2019

Tennessee’s health care system is in rough shape. Our state has lost 1 out of every 6 doctors and nearly 20% of its hospitals in just 10 years. Today, 2.5 million Tennesseans lack adequate access to care.  

This is a looming crisis for Tennessee. Our families, friends and neighbors must receive medical care when they need it. They should be able to do everything they can to meet their health care needs, with as little government intrusion as possible. 

This brings me to surprise medical billing, one of the biggest issues patients in Tennessee and across our nation face on a regular basis. Imagine you are in an accident that lands you in the emergency room. The hospital you visit is part of your insurance plan’s network, you receive treatment, pay your copay, and your expenses for the visit are covered. Or so you thought.  

The hospital was in network, but the doctor wasn't

Months later, you receive an unexpected bill for thousands of dollars for the treatment. How can this be if the hospital you visited was in your insurance plan’s provider network? Your insurance company explains to you that while the hospital was in network, one of the doctors providing care was not. There is nothing you can do to dispute the charge and you’re stuck wondering how to pay the massive bill. This is also a common scenario when patients go to an in-network hospital for surgery or other procedures. It’s far too common. 

No Tennesseans should be afraid to seek medical care, especially now, when so many in our state are facing barriers to health care access, but the possibility of receiving a massive bill will discourage them from doing so. Anyone could receive a costly, unexpected medical bill, especially considering that 1 in 5 hospital visits results in a surprise medical bill. We must put an end to this practice.  

Government-set price controls backfire

But government-set price controls — one solution under consideration — are not the answer. According to PolitiFact, a spokesperson for Physicians for Fair Coverage cites the effects surprise billing price controls had in California: doctors kicked out of network and increased insurance premiums for patients. Government-mandated pricing doesn’t work.  

If Congress is going to try to fix the surprise billing problem, there’s a better way. We have to empower patients by giving them a voice in the medical billing process. But asking your mother or your grandfather to do battle with an insurance company isn’t going to work. That’s why I have joined with Rep. Phil Roe (R-TN-1) and Rep. Raul Ruiz (D-CA-36) in proposing legislation (H.R. 3502) that gives patients a seat at the table by laying out an arbitration process that is fair to everyone involved. This system will reduce health care costs for patients while doctors are paid an appropriate market rate for their services.  

Government can help set the table, but government should not set prices. 

I will fight for every Tennessean's ability to stand up for themselves when they feel the health care system is taking advantage of them. It is unacceptable to allow surprise medical billing to continue. For Tennesseans and their families, the cost of doing nothing is far too high.  

U.S. Rep. Tim Burchett is the former mayor of Knox County.