In early May, President Trump announced efforts to end the practice of surprise medical billing, saying “For too long, surprise billing…has left some patients with thousands of dollars of unexpected and unjustified charges for services they did not know anything about and sometimes services they didn't have any information on.” The President is right: too many patients know the experience of enduring emergency or essential medical care and then being hit with a financial penalty through no fault of their own. The President’s focus on this issue—also known as balance billing—should be applauded.
That is why the Medical Society of Virginia, a membership association representing Virginia’s 30,000+ physician community, worked this past state legislative session to end balance billing in the Commonwealth. We supported House Bill 1714 and Senate Bill 1763, both of which would prohibit balance billing for emergency care and require out-of-network doctors be paid a regional commercial average, not by patients, but by their insurance company. By paying doctors this regional commercial average, insurers and doctors could handle the financials, making life and recovery better for patients who have just received medical care.
In addition, the bill ensured that insurance cover the care provided, regardless of the final diagnosis. Doctors in Virginia believe health insurance companies should not be allowed to refuse to cover the care their member receives if it turns out that the patient wasn’t having an emergency. This practice hurts patients.
Despite unified support from the physician, hospital and patient communities, HB 1714 and SB 1763 were both killed due to lobbying efforts by the health insurance industry.
Rather than work with the health care community to help end surprise medical bills for emergency care, the health insurance industry was more concerned with their bottom-line. And rather than pay out-of-network doctors a regional commercial average for emergency services provided, the insurance lobby wanted to have total control and force physicians to accept an in-network average for that specific insurer (for example, whatever Anthem’s going rate might be). This would eliminate a doctor’s ability to choose which insurance companies they work with and further monopolize the health insurance industry.
To be clear, doctors may be out of network for several completely valid reasons. Some insurance companies limit the number of doctors allowed to join a plan. Some health insurance plan’s reimbursement rates (what they pay doctors for a service) are significantly lower in comparison to others. And some doctors may not take certain plans because the restraints and paperwork required are beyond the available bandwidth of their practice and staff. If doctors were ever forced to take an insurance plan’s rates—it would jeopardize a doctor’s ability to provide quality care and make it harder for them to hire qualified staff (customer care reps, nurse practitioners, physician assistants, etc.).
The logic on this is simple. Imagine asking a restaurant to take $10 for a steak dinner instead of the menu price of $30. If this happened enough times, you’d imagine the restaurant would be forced to cut staff and use ingredients that were affordable instead of high-quality. Eventually the 4-star steakhouse becomes a 1-star dive. It might even have to close rather than sacrifice quality. When it comes to a solution for balance billing in Virginia, that is what the insurance industry wants for doctor’s offices. Like the restaurant’s decline would hurt customers, the decline in this instance would hurt patient care across the Commonwealth.
In an emergency, it is unsafe and illegal for a doctor to determine treatment based on insurance. A physicians’ priority is providing their patients with the immediate care they need. The idea that a patient should live in fear of a surprise bill after they have broken their leg or had a stroke is heartbreaking. Virginia must remove patients from this billing process.
As the federal government debates balance billing, this is an opportunity for Virginia to once again lead the way. The Medical Society of Virginia stands ready to work with the General Assembly, hospitals, and health insurers to find a solution to this problem that puts patients and their care first.
Dr. Richard Szucs is a Radiologist in Richmond, VA and President of the Medical Society of Virginia.