TEAMHEALTH SUPPORTS A BAN ON SURPRISE MEDICAL BILLING
At TeamHealth, we believe that federal legislation to address surprise medical billing must protect patients and require insurer accountability, transparency and reasonable limits on a patient’s out-of-pocket costs.
What is Surprise Medical Billing?
Surprise medical bills occur when patients receive out-of-network care and then receive a bill days or weeks later because their insurer failed to cover the cost of their care. It is a complicated issue that has put patients in the middle of a reimbursement battle between providers and the commercial insurance industry.
Recently, commercial insurance companies have taken great strides to reduce emergency clinician reimbursement by as much as 30%. Insurers also now routinely shift costs to patients in the form of increasing out-of-pocket charges like deductibles, co-insurance and copayments. This has led to patients receiving large bills from providers that historically were silently reimbursed by commercial insurance, also known as the surprise medical bill.
Protecting Access to Care
Today, more than 85% of the care delivered by TeamHealth emergency medicine doctors across the country is in-network with insurance companies. In 2018, TeamHealth provided emergency medical services for 16 million hospital-based emergency department visits. We deliver care to all patients who seek us out, regardless of their source of insurance, lack of insurance or ability to pay for care they receive. In fact, 75% of our patient encounters are reimbursed by Medicare or Medicaid or the patient is uninsured. This means 75% of the patient care we deliver is not reimbursed at a level that covers the cost of delivering it.
Like other emergency medicine providers, we rely on insurance companies to off-set this underfunded and uncompensated care. This arrangement between providers and insurance companies creates a way for all patients to receive emergency care – including the uninsured and indigent, who otherwise would have nowhere else to turn.
Without the commercial insurance industry’s willingness to sustain the cost for underfunded and uncompensated care, the most vulnerable and most acutely sick are left without access to care. In addition, rural communities that often do not have a large number of commercially insured patients face the threat of their local hospitals being forced to close or ration services.
TeamHealth has been actively engaged with federal lawmakers to develop a legislative solution that protects patients by eliminating surprise medical billing.
- TeamHealth has a longstanding policy against surprise medical billing. Even though insurers frequently ask us to pass the costs on to patients, we simply refuse to engage in that practice.
- Instead, we opt to take legal action to require insurers to uphold their financial commitments to their own customers because we do not believe that patients should be in the middle of a reimbursement dispute between a provider and an insurance company.
TeamHealth opposes proposed legislation that that gives insurance companies more power and allows them to increase their record-setting profits.
- The outcome to this issue that most insurance companies prefer will significantly hurt your family’s ability to see a doctor and would put many doctors and hospitals (especially those in rural communities) out of business.
- Unfortunately, insurance companies prefer a solution that comes with dire consequences: driving payments down to unsustainable levels, higher costs for patients and potentially forcing doctors and hospitals out of business. The insurance industry is lobbying the federal government aggressively to back a plan that threatens the critical social safety net that is at the core of emergency medicine across America.
There is a big difference in “surprise medical bills” and “out-of-network” bills.
- Surprise medical bills occur when patients receive out-of-network care and then receive a bill days later because their insurance company refused to cover the cost.
- This most often happens in emergency care, when patients experiencing a medical emergency do not have the opportunity to check to see if the hospital or the physicians are in-network and visit a hospital that is committed to treating all patients regardless of their ability to pay.
- Surprise medical bills have increased over the years because insurance companies are moving customers to high deductible plans that include high out-of-pocket expenses. This situation is increasing as a function of insurance companies seeking to shift costs to patients via higher out-of-pocket costs.
TeamHealth believes that if passed, the proposed legislation that the insurance companies prefer will produce a number of dire, frightening consequences for providers, hospitals and families across America.
- Rural hospitals may be forced to close or ration care.
- The number of clinicians who staff America’s emergency departments will decline.
- The quality of care patients received in our nation’s emergency departments will decline.
- Costs that insurance companies tell us will go toward lower premiums will in fact be used to increase insurance company profits.
- As the number of physicians staffing our nation’s emergency rooms declines, overall healthcare expenditures will increase
TeamHealth supports the principles behind H.R. 3502, the Surprise Medical Bills Act, to find a solution to this issue that protects patients to vital emergency care services and does not undermine our nation’s delivery system.
- H.R.3502 includes protections for patients and guarantees that insurance companies are accountable to the government and to their customers. This bill couples a fair interim payment with an impartial, third-party arbitration process known as Independent Dispute Resolution (IDR).
- IDR is already in place in Texas and New York, two states with very large emergency department volumes, and is working fairly for all parties involved. We believe IDR could work on a national scale to address this important issue.