John Barrett III: Good Neal plan on surprise medical bills

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NORTH ADAMS — As a longtime elected official from Berkshire County, I understand how difficult it can be for people in rural communities to access the healthcare they need and deserve. This, coupled with the fact that healthcare choices are limited to begin with. There are often few options when visiting a specialist or an emergency room. In Western Massachusetts, too many healthcare facilities have closed or consolidated in recent years, leaving residents to travel long distances to get access to hospitals and physicians, especially specialists.

When patients get hit with medical bills from out-of-network providers — even if they did not know the provider wasn't in their network — it undermines their confidence in the healthcare system and can lead to severe financial hardship. Medical bills can mount quickly, and they are a leading cause of bankruptcy in the United States.

To illustrate the "surprise medical billing" problem, when a patient is taken by ambulance to a hospital emergency room, the ER visit may be covered by insurance. But the ER doctor may not be, and so the insurance company sends the patient a hefty bill to cover all or part of the doctor's services. Most people, quite reasonably, think that if the hospital is in-network, everyone working there will be too.

PROFIT-FIRST INSURERS

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Unfortunately, many of the legislative fixes that are being discussed in Congress are hand-outs to insurance companies, which are more concerned with profits than ensuring patients have the care they need. If the insurance companies have their way through a "rate-setting" plan, they will be able to artificially set below-market reimbursement rates and stick doctors and hospitals with greater costs for treating patients, while reaping huge profits. In rural areas like Berkshire County, this will jeopardize the few health care options we have. Instead, we need legislation that prioritizes patients and those healthcare professionals and providers who are on the front lines of saving lives.

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Fortunately Congressman Richard Neal is the chairman of the House Committee on Ways and Means which has jurisdiction over this matter. Chairman Neal has worked hard over the past couple years with Democrats and Republicans to find a reasonable path forward to resolve the issue of surprise medical billing — all with the intention of protecting the patient. In contrast to the insurance industry-leaning proposals that have been put forth, Congressman Neal has introduced bipartisan legislation that would end the financial strain that comes with surprise medical bills. This is a plan that allows for Independent Dispute Resolution and equally important, a plan that is supported by the Massachusetts Health and Hospital Association.

N.Y. STATE MODEL

With Independent Dispute Resolution, patients are taken out of the middle in billing disputes between insurers and providers. Instead, an objective, third-party mediator works to determine fair-market value for healthcare services provided.

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The state of New York has implemented Independent Dispute Resolution and the system works well there, with a reduction in more than 2,500 surprise medical billing cases saving consumers over $400 million. This can, and should, be the model Congress adopts nationally to protect patients and preserve access to live-saving medical treatments.

Surprise medical billing is a growing problem that calls out for a reasonable solution to protect patients and preserve access to care in rural communities like many of those in Western Massachusetts. Hopefully in the coming months Congressman Neal's colleagues in Congress will embrace his proposal of Independent Dispute Resolution.

John Barrett III is the state representative for the First Berkshire District.


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