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Protecting Patients From Surprise Medical Bills

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Patients should never be surprised by unexpected bills for out-of-pocket costs for emergency or unplanned health care services. That seems straightforward enough. Yet, increasingly they are on the receiving end of surprise bills, many of which have hefty price tags.

Solving this problem is….surprisingly….simple. Remove the patient from the equation.  And keep the rest of current state law that specifies mediation as the process for negotiating payments between health plans and out-of-network health care providers.

Since the beginning of the legislative session, Texas hospitals have supported two things: 1) protecting patients from unfair bills and 2) maintaining the existing mediation process for providers and plans to come to a mutually acceptable payment amount, without the interference of government rate setters.

We applaud the bipartisan group of lawmakers working to solve this issue. It’s not an easy task, and yet they have forged alliances across the aisle to put patients first. This is to be commended.

Yet, the current leading proposed solution has become unduly complex and unwieldy. Worse, it could have unintended and detrimental effects for the very people we all want to help – patients. And it could set a dangerous precedent for government control of provider payments.

In health care, providers strive first to “do no harm.” This adage is wise counsel for health care policy as well. Replacing the current process of mediation, which works well and yields fair outcomes for plans and providers alike, with binding arbitration could very well do significant harm. It could, for example, narrow health plans’ provider networks and limit patients’ choice of providers. It could also establish a slippery slope towards more government control of health care. And it’s costly. The Teacher Retirement System and Employee Retirement System estimate that arbitration would cost their systems $60.5 million and $14.7 million, respectively.

None of these outcomes is desirable. Fortunately, all are avoidable.

Remove patients from the equation. Maintain mediation. Simple.

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