Health Care

Transparency touted as solution to surprise medical bills

October 31, 2019

Ray Carter

To combat the problem of “surprise” medical bills, experts encouraged Oklahoma lawmakers to ban “balance billing” Oklahoma consumers and to increase health-care price transparency.

“If a patient is in a situation where they have not chosen to go out of network—where they didn’t know; they didn’t have an opportunity—then they should not be the one left to pay that bill,” said Buddy Combs, deputy commissioner of licensing at the Oklahoma Insurance Department.

LeAnne Gassaway, senior vice president of state affairs and policy for America’s Health Insurance Plans, said 20 percent of people have had a surprise medical bill. Because few hospitals directly employ doctors, and instead are engaged in a contractual relationship with those medical officials, Gassaway said it is common for a doctor to be in a different insurance network than the hospital where the doctor performs surgery. As a result, a patient may receive services believing everything is in-network, only to find out otherwise when the patient receives a large bill for the difference between the in-network insurance payment and the total price billed by the out-of-network provider.

“We all agree that banning balance bill is paramount,” Gassaway said.

Jonathan Small, president of the Oklahoma Council of Public Affairs, noted there was broad agreement that if a patient goes to a facility and has reason to believe the facility is in their insurance network, “then they shouldn’t be balanced billed.”

“So the Legislature ought to feel empowered today,” Small said. “You can pass that because you heard a lot of agreement here.”

But he said lawmakers could take other meaningful steps that will make it easier for patients to avoid surprise bills.

“The problem is price,” Small said. “That’s the real problem in health care, and it’s not transparent.”

Small urged lawmakers to require greater transparency to drive down “surprise” medical bills. Among other things, Small told lawmakers they should make it illegal to attach a medical bill to a patient’s credit report unless the patient has been provided the bill in advance of care.

“You want to talk about providing transparency for patients and putting them in the position to know what things cost,” Small said. “That’s what happens with most of the other things they buy.”

Small said single employers and self-funded plans should also be given access to claims data, and that state-owned or state-operated hospitals should be required to display what they pay for the top 500 procedures.

“We’ve all heard it said that sunlight is the best disinfectant,” Small said. “So we feel like, in order to get sunlight, people need to be able to see what is being paid.”

Claims data will allow consumers to determine what providers offer the best financial value, he said.

Dan Chepkauskas, founder and executive director of the Patient Choice Coalition, voiced similar views, telling legislators that with health insurance “you don’t know what the value of it is.”

“You find out after the fact,” Chepkauskas said. “There is no transparency.”

And where price transparency exists, he noted insurers are actually driving patients away from low-cost, high-quality health care.

“We talk about surprise billing. We have two, brand-new, physician-owned, free-market, posting-prices, micro-hospitals,” Chepkauskas said. “They’re located here in the state of Oklahoma. And both of them are being squeezed out.”

The fact that Oklahoma’s insurance market is dominated by just one or two insurance carriers contributes to that squeezing-out problem, he said.

Jennifer Schmitt, government relations chair for the Oklahoma Association of Nurse Anesthetists, agreed that transparency would aid consumers, but adopting those reforms will require overcoming the resistance of established players in the medical field.

“Competition and choice are always good for patients, always good for price transparency,” Schmitt said. “Many insurers and providers don’t really want to publicize price information.”

Yet she noted the lack of transparency reduces consumer options.

“If they don’t publish it, that inhibits competition, it inhibits choice,” Schmitt said.

The study on surprise medical bills, conducted by members of the House Insurance Committee, was requested by Rep. Chris Sneed, R-Fort Gibson, and Rep. Tammy Townley, R-Ardmore.

Townley said she has personal reasons for seeking to resolve the medical-billing issue.

“This is a problem, and the reason I was interested in it—on a personal note—is because I was one of those families who got one of those huge surprise bills from a surgeon,” Townley said. “We know that there are concessions to be made on both sides, the hospitals and insurance companies, but our goal is to protect our Oklahoma constituents.”

Some officials at the meeting told lawmakers that other reform efforts could require arbitration between insurers and providers when balance billing would otherwise exist, or mandate the use of benchmark rates, such as the 80th percentile of charges, to determine payment in those cases.

Those proposals met with varying degrees of support and opposition from medical officials present.

Schmitt said that’s not surprising. While a ban on balance billing drew broad support, proposals involving arbitration or benchmark rates hit closer to home for many providers, she said.

“It’s more of the breakdown of ‘who is going to have to take less money?’” Schmitt said. “So it’s a difficult, tough issue.”

Even so, House Insurance Committee Chair Lewis Moore, R-Edmond, appeared optimistic legislation will pass next year to end most surprise medical billing.

“The solutions are within our grasp,” Moore said. “I don’t know why it’s taken so long to get it to where it needs to be.”