You may have seen the recent activity in Congress on surprise medical billing.

When presented with a patient specimen, I don’t wait in the laboratory to check the patient’s insurance. I run the right tests and review the slides at my microscope to diagnose disease. The billing for the medical service comes later.

As a physician, my colleagues and I support holding patients financially harmless from unexpected out-of-network medical bills. Physicians want to be in-network and accept the insurance plans covering their patients. Often, it’s the health insurer who drops physicians or refuses to contract with those who wish to join.

Congress needs to adopt a federal legislative proposal that includes network adequacy standards that require health plans to contract with the right numbers of physicians practicing at in-network hospitals. Any legislative proposal should also ensure that insurers and providers can negotiate reimbursement for services in an equitable manner.

Several of the proposals in Congress hand all the negotiating power to insurers. Congress should establish a fair payment formula for out-of-network physician care and use an arbitration process that allows a doctor and insurance company to settle a bill through a third-party process.

Congress must take a serious look at the proposals several physician members of Congress, led by Reps. Raul Ruiz and Phil Roe, have recently released. Their proposal is a positive step in the right direction.

Lyle Noordhoek, MD, FCAP
Hays
President, Kansas Society of Pathologists