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Congress can stop surprise med bills

As Pennsylvania’s newest member of Congress, Rep. Fred Keller, R-12th District, has a great opportunity to serve our district by becoming a champion for legislation to stop surprise medical bills.

A sensible solution to this growing problem will help local families save money and support health care competition. But only the right legislation will help improve access to care and control health cost inflation.

Surprise medical bills arise when a patient unknowingly receives out-of-network treatment, usually for emergency care, but for non-emergency care as well. In the case of a bicycle accident, you might be rushed to the nearest hospital and then receive care from an ER doctor, an orthopedic surgeon, a radiologist, a neurologist, an anesthesiologist, and other specialists.

Even if you have gold plan insurance coverage, the hospital or any one of the specialists might be out of network. Instead of being billed for your expected co-pay, you could receive surprise medical bills for thousands of dollars.

For some families and individuals, the consequences of a surprise medical bill can be dire. Hospitals and medical providers often offer payment plans, but high bills can damage your credit, eat into savings, and even jeopardize your ability to keep a roof over your head.

This financial stress can further hurt a patient’s health and undermine recovery. With a growing number of families caught in this situation, it is past time for Congress to fix this problem.

Fortunately, several congressional committees have already debated this issue and will consider proposed legislation — including the House Education and Labor Committee, on which Rep. Keller sits.

Both House and Senate proposals include the most important provision; namely, helping families by taking patients out of any dispute entirely. In the case of unexpected charges, patients will only pay in-network costs.

But now Congress needs to complete work on the other main component of the issue — determining how medical providers and insurers should negotiate cost disputes.

Neither side should be able to dictate pricing, which would be unfair and anti-competitive.

But just as important — especially for reaching bipartisan consensus — benchmarking based on Medicare rates should also not be used to set prices.

The Pennsylvania Medical Society supports an alternative approach where rates are set by a national reference claims database that is conflict free and not affiliated with or controlled by providers or insurers. This ensures fair and reasonable rates are set that reflect the true cost of care, which helps local hospitals remain strong and stable so no patient’s access to quality care is compromised.

If there is a dispute, we must have a fair and transparent independent resolution process administered by the Pennsylvania Insurance Department that is streamlined, efficient, and targeted only on the net amount in dispute.

While health care policy has been a source of partisan rancor and gridlock, addressing surprise medical bills should be an issue that rises above the fray. Surprise medical bills hit patients regardless of their political party, and this solution navigates a middle road that supports competition and private insurance.

It is a perfect issue for a freshman member of Congress such as Fred Keller to notch a victory for his constituents.

Dr. Danae Powers, a practicing anesthesiologist who resides in State College, is president of the Pennsylvania Medical Society.

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