Many medical providers and insurance companies prefer that consumers pick up some of the tab for emergency room care. That’s not right.
AN Olympia resident, Dave, went to a Thurston County emergency room last year because of a life-threatening heart condition. While he received treatment that saved his life, he also ended up with a shock he never expected — a surprise medical bill of more than $1,400.
Dave did what we asked him to do — he got health insurance. And when he had an emergency, he went to his health plan’s approved hospital. He did everything right. But no one ever told him he might be treated by doctors at his plan’s hospital that were out of his network. Through no fault of his own, Dave was hit with a surprise medical bill.
Unfortunately, Dave’s story is increasingly common in Washington and across the nation. People are getting surprise medical bills for hundreds to thousands of dollars that they did not expect and do not deserve.
That is why I am urging the Legislature to approve SHB 2447. It is a fair consumer-protection proposal that says when a billing dispute arises because an out-of-network emergency-room provider charges excess amounts, the insurer and provider need to work it out, and leave the patient out of it. If the two parties cannot reach agreement, the last resort is binding arbitration.
As expected, many providers and insurance companies oppose this legislation. They prefer the status quo of consumers picking up the tab for something they never expected.
Specifically, the Washington State Medical Association advocates that insurers be required to pay 100 percent of “billed charges,” or any amounts that are part of surprise emergency-room bills when the provider is not contracted with a health insurer. Their position offers no room for negotiation and would not help keep health care affordable.
If insurers are forced to pay whatever bills are submitted, those costs will be passed along to consumers. And there will be even less incentive for emergency room specialists to be part of a transparent, contracted provider network.
Opponents also say that surprise billing rarely happens. The data say otherwise. The American College of Emergency Physicians reviewed 750,000 patient visits at Washington hospitals last year and found that surprise billings occur “only” about 3 percent of the time. That’s more than 22,000 Washington consumers. A recent survey of Washington consumers by Consumers Union showed that about one in three residents received a surprise bill that was more than they expected.
I can tell you if it happens to you or a loved one, you would be outraged — and rightly so.
No one who has insurance and goes to their in-network hospital deserves a surprise bill after they have just survived one of the most vulnerable experiences in their lives — a sudden visit to a hospital for a medical emergency. My proposal offers a reasonable and workable compromise.
Thirteen other states, including Illinois, California and New York have taken reasonable steps to protect consumers against surprise medical bills. It’s time Washington state joins them.