Surprise medical billing is an insurance network problem not a federal government problem.

Ophthalmologist Jane Hughes, MD of San Antonio writes in:

Let’s all get on the same page about one thing. Surprise medical billing is not a federal government problem.

It is a contractual problem between the insurance company and the insured patient, largely because no one reads the fine print. It is also the direct result of networks.

There are steps that states can take that would largely solve the surprise billing that insurance has perpetrated and one step is mandatory price transparency.

On a federal level issues that are their purview involve Medicare/Medicaid. Mandatory price transparency and a concomitant rule that regardless of who is paying, the charge for the identical service or product at the same facility by or from the identical provider must be the same.

This is not price fixing as each entity decides the fee for product or service rendered. Just like a gallon of milk at a specific grocery store is the same regardless of credit card used, cash, or food stamps.

Gee, what a novel idea…

California Bill is Bad for Everyone But Insurers

California’s legislature just gave a gift to the insurance and managed care industry and it’s bad news for independent physicians and their patients.

AB 72 is on the way to Governor Jerry Brown’s desk. This bill will not fix the surprise medical bill problem it claims to solve and it will harm patients’ access to medical care by independent physicians.  Insurers will in many cases be able to dictate the fees of out-of-network physicians and the result could be devastating for these doctors.

Doctors in California have sent an emergency request to Governor Brown, asking him to veto this bad bill. It reads in part:

Promoted misleadingly as a means to end ‘surprise billing,’ AB 72 will actually enrich insurance companies while creating shortages of care for patients. Patients are increasingly being forced into narrow networks, in order to cut costs for insurers. The care they need is often not available in the network. Many physicians stay out of network because the extremely low in-network fees they are allowed to charge wouldn’t cover the costs of keeping their doors open…. [T]his bill will exacerbate California’s current physician shortage. Hospital call panels that provide emergency and also safety-net care for uninsured and under-insured Medi-Cal patients will be unable to deliver adequate specialty services.

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