Prioritizing Patients and Providers Over Billing Surprises and Windfalls

by Matthew Hallisey

The first week in September was Kidney Disease Awareness Week in Connecticut. As a volunteer for the National Kidney Foundation and the Polycystic Kidney Disease (PKD) Foundation, I am proud to say that I helped to successfully support adoption of Senate Bill 1091 in 2019, which raises awareness of chronic kidney disease in Connecticut. I’m committed to continuing to work on these issues to help find a cure for PKD and other kidney diseases.

It is from this perspective that I am voicing my concern about S. 1865, Lower Health Care Costs Act, which the Senate is considering as a way to address “surprise” medical billing. Unfortunately, my family is no stranger to surprise bills. Many patients like my parents and in-laws have been hospitalized recently for various age-related illnesses and it can be very challenging for an elderly person or his or her family to receive unexpected medical bills when they’re given out-of-network care at an in-network hospital.

The practice of submitting a massive bill to a patient for out-of-network services is an egregious side effect of insurance network deficiencies, but the proposed solution may inadvertently hurt patients.

The practice of submitting a massive bill to a patient for out-of-network services is an egregious side effect of insurance network deficiencies, but the proposed solution may inadvertently hurt patients.

Congress is right to prioritize patient protection, but if the current Senate bill is not amended, patients and providers could both be harmed while insurers unfairly increase their profits. This is because the Senate bill includes a system called “rate-setting.”

When patients face unresolved surprise bills, someone must ultimately pay the cost for services provided. Rate-setting imposes a price ceiling for a given medical service or treatment, so when insurance companies reimburse providers for out-of-network care, they may be underpaying for certain services.

This isn’t the only available solution to surprise billing, but it is the one that promises a windfall to insurance companies at the patient’s expense. In a worst-case scenario, it could severely deplete resources from the hospitals and clinics that patients depend on for care.

I urge members of the U.S. Senate Health, Education, Labor, and Pensions Committee, including Senator Murphy, not to gamble with the quality of patient care. Patients need relief from surprise billing, but insurance companies should not be allowed to shortchange doctors in the process.

Connecticut resident Matthew Hallisey is a volunteer for the National Kidney Foundation and the Polycystic Kidney Disease (PKD) Foundation.